Constrictive Pericarditis Surgical Procedure: A Step-by-Step Guide

Constrictive pericarditis is a condition where the pericardium becomes thickened and rigid, restricting the heart's normal function. Surgical intervention is often necessary to restore cardiac performance and improve quality of life. The surgical procedure involves several key stages, each designed to ensure patient safety and long-term recovery.

Preoperative Preparation

Before undergoing surgery, patients often experience complications such as fluid retention, low protein levels in the blood, liver dysfunction, and systemic edema. These symptoms must be carefully managed to optimize the patient's condition prior to the operation. Medical professionals may prescribe diuretics to reduce fluid buildup and administer nutritional support to correct hypoalbuminemia. The goal is to stabilize the patient and minimize surgical risks.

Anesthesia and Incision

General anesthesia is required for the procedure, though the use of cardiopulmonary bypass is typically not necessary. Once the patient is anesthetized, the surgeon makes an incision through the left anterior chest wall, accessing the pericardial space. This approach allows for optimal visualization and access to the affected area.

Pericardiectomy Procedure

Pericardial Removal

The core of the surgery involves the meticulous removal of the thickened and adhered pericardium. Surgeons carefully dissect the abnormal tissue to avoid damaging the underlying heart muscle and major blood vessels. Complete resection of the constrictive pericardium is crucial to relieve the mechanical restriction on the heart.

Drainage Placement

After the pericardium is removed, drainage tubes are placed to prevent fluid accumulation in the pericardial space. These tubes help monitor postoperative bleeding and reduce the risk of tamponade or infection.

Postoperative Recovery

Once the surgical site begins to heal and the drainage output decreases, the tubes are removed. Patients are closely monitored in the recovery phase for any signs of complications such as arrhythmias, bleeding, or heart failure. Early mobilization and gradual resumption of normal activities are encouraged to promote healing.

Long-Term Follow-Up

Regular follow-up appointments are essential after surgery. Echocardiography is performed periodically to assess cardiac function and to monitor for any recurrence of pericardial thickening or fluid accumulation. Long-term outcomes are generally favorable when the procedure is performed successfully and complications are avoided.