Pericardiectomy: Difference between revisions
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The procedure begins when the [[surgeon]] makes an incision in the skin over the [[breastbone]] and divides it to expose the pericardium. During the surgery, the surgeon will grasp the pericardium surrounding the heart, and will remove the fibrous, calcified or infected tissue covering of the [[heart]]. Once the pericardium is removed, the surgeon will wire the breastbone back together, the incision is closed, and the procedure is completed. | The procedure begins when the [[surgeon]] makes an incision in the skin over the [[breastbone]] and divides it to expose the pericardium. During the surgery, the surgeon will grasp the pericardium surrounding the heart, and will remove the fibrous, calcified or infected tissue covering of the [[heart]]. Once the pericardium is removed, the surgeon will wire the breastbone back together, the incision is closed, and the procedure is completed. | ||
==Use in Patients with Tuberculous Pericarditis== | |||
===Pericardiectomy=== | |||
[[Pericardiectomy]] is the surgical removal of the pericardium. It may be adopted in treatment of recurrent [[pericardial efussion]] due to [[TB]], in tuberculous [[constrictive pericarditis]] or if there is no hemodynamic and general improvement after 4-8 weeks following [[TB#treatment|antituberculosis chemotherapy]]<ref name="pmid16330703">{{cite journal| author=Mayosi BM, Burgess LJ, Doubell AF| title=Tuberculous pericarditis. | journal=Circulation | year= 2005 | volume= 112 | issue= 23 | pages= 3608-16 | pmid=16330703 | doi=10.1161/CIRCULATIONAHA.105.543066 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16330703 }} </ref>. If it is performed in the early stages of TB pericardial constriction, pericardiectomy has a low mortality rate when compared to advanced stages of the disease where pericardiectomy is poorly tolerated. Mortality rate secondary to this procedure is 3-16%<ref name="pmid7112301">{{cite journal| author=Fennell WM| title=Surgical treatment of constrictive tuberculous pericarditis. | journal=S Afr Med J | year= 1982 | volume= 62 | issue= 11 | pages= 353-5 | pmid=7112301 | doi= | pmc= | url= }} </ref><ref name="pmid3175976">{{cite journal| author=Bashi VV, John S, Ravikumar E, Jairaj PS, Shyamsunder K, Krishnaswami S| title=Early and late results of pericardiectomy in 118 cases of constrictive pericarditis. | journal=Thorax | year= 1988 | volume= 43 | issue= 8 | pages= 637-41 | pmid=3175976 | doi= | pmc=PMC461401 | url= }} </ref>. This surgery should be undertaken under the coverage of antitubercular drugs. | |||
Treatment of [[Tuberculous pericarditis#Pathophysiology|effusive constrictive pericarditis]] is challenging because [[pericardiocentesis]] does not relieve the impaired filling of the heart, and surgical removal of the fibrinous exudate coating the visceral pericardium may not be possible. Patients should be started on antitubercular drugs and serial [[echocardiography]] should be performed to monitor the changes of [[pericardium]] and to make a decision regarding its surgical stripping<ref name="pmid16330703">{{cite journal| author=Mayosi BM, Burgess LJ, Doubell AF| title=Tuberculous pericarditis. | journal=Circulation | year= 2005 | volume= 112 | issue= 23 | pages= 3608-16 | pmid=16330703 | doi=10.1161/CIRCULATIONAHA.105.543066 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16330703 }} </ref>. | |||
==Complications== | ==Complications== | ||
The procedure can be complicated by perforation or tearing of the heart muscle if the heart muscle is tightly adherent to the pericardium. Stated simply, removal of the pericardium can remove the densely adherent heart muscle itself which is a catastrophic complication. | The procedure can be complicated by perforation or tearing of the heart muscle if the heart muscle is tightly adherent to the pericardium. Stated simply, removal of the pericardium can remove the densely adherent heart muscle itself which is a catastrophic complication. | ||
==References== | |||
{{Reflist|2}} | |||
{{Cardiac surgery and other cardiovascular procedures}} | {{Cardiac surgery and other cardiovascular procedures}} | ||
Revision as of 16:25, 29 June 2011
| Pericardiectomy | |
| ICD-9 | 37.31 |
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| MeSH | D010492 |
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Pericarditis Microchapters |
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Diagnosis |
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Treatment |
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Surgery |
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Case Studies |
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Pericardiectomy On the Web |
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American Roentgen Ray Society Images of Pericardiectomy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Keywords and synonyms: Pericardial stripping
Overview of the Procedure
Pericardiectomy is the surgical removal of part or most of the pericardium. This operation is performed to relieve constrictive pericarditis, or to remove a pericardium that is calcified and fibrous.
The procedure begins when the surgeon makes an incision in the skin over the breastbone and divides it to expose the pericardium. During the surgery, the surgeon will grasp the pericardium surrounding the heart, and will remove the fibrous, calcified or infected tissue covering of the heart. Once the pericardium is removed, the surgeon will wire the breastbone back together, the incision is closed, and the procedure is completed.
Use in Patients with Tuberculous Pericarditis
Pericardiectomy
Pericardiectomy is the surgical removal of the pericardium. It may be adopted in treatment of recurrent pericardial efussion due to TB, in tuberculous constrictive pericarditis or if there is no hemodynamic and general improvement after 4-8 weeks following antituberculosis chemotherapy[1]. If it is performed in the early stages of TB pericardial constriction, pericardiectomy has a low mortality rate when compared to advanced stages of the disease where pericardiectomy is poorly tolerated. Mortality rate secondary to this procedure is 3-16%[2][3]. This surgery should be undertaken under the coverage of antitubercular drugs.
Treatment of effusive constrictive pericarditis is challenging because pericardiocentesis does not relieve the impaired filling of the heart, and surgical removal of the fibrinous exudate coating the visceral pericardium may not be possible. Patients should be started on antitubercular drugs and serial echocardiography should be performed to monitor the changes of pericardium and to make a decision regarding its surgical stripping[1].
Complications
The procedure can be complicated by perforation or tearing of the heart muscle if the heart muscle is tightly adherent to the pericardium. Stated simply, removal of the pericardium can remove the densely adherent heart muscle itself which is a catastrophic complication.
References
- ↑ 1.0 1.1 Mayosi BM, Burgess LJ, Doubell AF (2005). "Tuberculous pericarditis". Circulation. 112 (23): 3608–16. doi:10.1161/CIRCULATIONAHA.105.543066. PMID 16330703.
- ↑ Fennell WM (1982). "Surgical treatment of constrictive tuberculous pericarditis". S Afr Med J. 62 (11): 353–5. PMID 7112301.
- ↑ Bashi VV, John S, Ravikumar E, Jairaj PS, Shyamsunder K, Krishnaswami S (1988). "Early and late results of pericardiectomy in 118 cases of constrictive pericarditis". Thorax. 43 (8): 637–41. PMC 461401. PMID 3175976.
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