Introduction
The pericardium is a thin sac around the heart. In constrictive pericarditis, this sac becomes thick, scarred and stiff, and squeezes the heart so that it cannot fill properly.
In pericardiectomy, the surgeon removes the thickened pericardium to free the heart. This allows the heart to fill and pump more normally.
Why the procedure is needed
A stiff, squeezing pericardium can cause:
- Breathlessness, tiredness and reduced ability to be active
- Swelling of the feet, legs and abdomen (fluid build-up)
- Distended neck veins, and fluid in the abdomen or around the lungs
- Poor appetite and weight changes from fluid retention
- Symptoms of right-sided heart failure that do not respond fully to tablets
Who may benefit
- People with constrictive pericarditis whose symptoms are not controlled well enough by medicines
- People whose condition follows tuberculosis, previous heart surgery, radiation or infection
- Patients assessed by echo, CT, MRI and sometimes catheter tests, whose heart is judged to be squeezed by the pericardium
- Not everyone with scarring needs surgery — some cases are temporary and improve with treatment of the underlying cause
How the operation works
- Removing the sac
- As much of the thickened pericardium as can be done safely is peeled off the heart surface.
- With or without the machine
- Many operations are done without the heart-lung machine; in some cases it is used for safety.
- Treating the cause
- Where the cause is known, such as tuberculosis, specific treatment for that cause is also given.
- Gradual improvement
- Symptoms often improve over weeks to months, and swelling goes down gradually.
- Timing
- Surgery is better done before the heart muscle becomes weak or severe swelling and wasting develop.
Procedure overview
Step 1: Evaluation
Echocardiography, CT or MRI and sometimes catheter pressure measurements confirm constriction and show how thick the pericardium is.
Step 2: Anaesthesia
General anaesthesia is used, with careful monitoring.
Step 3: Surgical access
The heart is reached through the breastbone or the side of the chest.
Step 4: Removing the pericardium
The surgeon carefully frees the heart from the thickened sac, removing it from the front and, where possible, the sides and lower parts.
Step 5: Monitoring
After surgery, drains are placed and the patient is monitored in intensive care, where fluid balance and heart function are watched closely.
Step 6: Recovery
Recovery takes several weeks, and fluid retention often settles gradually. Follow-up echoes check how the heart is filling.
Clinical advantages
- Frees the heart so that it can fill and pump more normally
- May relieve breathlessness, swelling and tiredness
- May reduce the need for water tablets over time
- Done at the right time, may prevent long-term damage to the heart and liver from fluid congestion
Risks and considerations
Every operation carries risk. The points below are general; your own risk depends on your health and on the operation you need.
- Bleeding, infection and the general risks of heart surgery
- Low heart output or rhythm problems after the heart is freed
- Injury to the heart muscle or heart vessels while removing a very stuck pericardium
- Symptoms may improve only partly, particularly if the heart muscle or other organs were already affected
- Risk depends on how advanced the disease is and on other health problems
Frequently asked questions
Is pericardiectomy a major operation?
Yes. It is a major heart operation, but when it is needed it can bring great relief. Your surgeon will explain the risks for your situation.
Will my swelling and breathlessness go away?
Many patients improve gradually over weeks to months. The degree of recovery depends on how long the condition has been present and on the heart muscle.
Is the pericardium needed?
The heart can function without most of its pericardium. Removing the thickened part allows it to move freely.
What is the cause of constrictive pericarditis?
It can follow infections such as tuberculosis, heart surgery, radiation or other conditions, and sometimes no cause is found. Treating the cause is also important.
What follow-up will I need?
Regular visits and echocardiograms. Your doctor will tell you when to reduce water tablets and when to expect improvement.
Patient-friendly summary
Pericardiectomy removes the thick, stiff sac around the heart so the heart can fill and pump freely again. It is a major operation that may bring gradual relief from breathlessness and swelling in carefully selected patients. A cardiologist and cardiothoracic surgeon decide if and when it is the right treatment.