Pericardiectomy is a surgical procedure in which all or part of the pericardium (the membranous sac surrounding the heart) is removed. It is most commonly performed to treat constrictive pericarditis, a condition in which the pericardium has become thickened, scarred, and inflexible, restricting the heart’s ability to fill normally.
In constrictive pericarditis, chronic inflammation of the pericardium (caused by previous infection, surgery, radiotherapy, autoimmune disease, or sometimes without a clear cause) causes the sac to fibrose and calcify. The resulting constriction prevents the heart chambers from expanding fully during diastole, causing features of heart failure including oedema, breathlessness, and abdominal swelling, even when the heart muscle itself is functioning normally.
Pericardiectomy aims to release the constriction and restore normal cardiac filling. The procedure involves removing as much of the scarred pericardium as is technically feasible, typically working around the coronary arteries and phrenic nerves. It is a major open heart operation requiring cardiopulmonary bypass in many cases. Outcomes are best when performed before the pericardial constriction has caused severe or irreversible myocardial damage. Surgical risk is higher in patients with extensive calcification or prior cardiac surgery.
Pericardiectomy can also be performed (less commonly) to treat large, recurrent pericardial effusions that cannot be managed by repeated drainage. Cardiac rehabilitation and appropriate follow-up are recommended after major pericardial surgery.
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