What is pericardiectomy?
Pericardiectomy is the surgical removal of a portion or all of the pericardium. It is also called pericardial stripping. The pericardium is a double-walled, membrane sac that surrounds the heart. It contains a small amount of fluid that lubricates the heart during its normal pumping movements within the pericardium.
What is the function of the pericardium?
The pericardium protects the heart from infection and other sources of disease and holds the heart in the chest wall. The pericardium contains about 50 cc of fluid that lubricates the heart during its normal pumping movements and prevents friction between the heart and the pericardium lining. The pericardium prevents the heart from over-expanding and keeps it functioning normally when blood volume increases due to conditions such as kidney failure, pregnancy or other causes.
Why would a patient require a pericardiectomy?
The most common reason for performing a pericardiectomy is constrictive pericarditis, a condition in which the pericardium has become stiff and calcified. The stiff pericardium prevents the heart from stretching as it normally does when it beats. This causes the heart chambers to fill incompletely with blood, and blood backs up behind the heart. The heart swells, and symptoms of heart failure develop.
Pericardiectomy also can be used to treat recurrent pericarditis, in patients with intractable recurrent symptoms and complications of the anti-inflammatory medications including steroids.
What causes constrictive pericarditis?
There are a number of causes for constrictive pericarditis. At one time, most cases of constrictive pericarditis were idiopathic, meaning the underlying cause was not known. In the past 20 years, this has shifted, and previous heart surgery and radiation to the chest are now leading causes of constrictive pericarditis.
Some other causes include:
- Diseases such as tuberculosis and mesothelioma
- Viral or bacterial infection
- Surgical complications
Can the heart function normally without a pericardium?
The pericardium is not essential for normal heart function. In patients with pericarditis, the pericardium already has lost its lubricating ability so removing it does not make that situation worse. Removing the pericardium does not cause problems as long as the patient’s lungs and diaphragm (the large, dome-shaped muscle below the lungs involved in breathing) are intact.
What options besides surgery are available for treating constrictive pericarditis?
Patients with less severe pericardium constriction may be treated with anti-inflammatory medications. When constriction of the pericardium comes on relatively quickly (within 3-6 months), a syndrome called transient constriction, it may be due in part to inflammation of the pericardium, and this condition may resolve with medications.
For the most advanced cases, surgical treatment is the best option and the one that we recommend.