Our Summary

This research paper discusses a condition called chronic constrictive pericarditis, which is caused by inflammation and scarring of the pericardium (the sac-like covering of the heart). This condition can lead to issues with the heart’s ability to fill with blood and can result in heart failure. Once diagnosed, the damage is irreversible and the standard treatment is a surgical procedure called a pericardiectomy.

The paper provides a video tutorial to visually explain the surgical process and offer useful tips. The surgery is typically performed through a cut down the middle of the chest, preferably without the use of a heart-lung machine. The surgery involves removing the entire front part of the pericardium (from one side of a major nerve to the other) and parts of the pericardium attached to the diaphragm and behind the nerves.

Before the actual pericardiectomy is performed, it’s helpful to separate the hard pericardial shell from the lung lining and diaphragm. This step allows the surgeon to clearly see the major nerves and define the boundaries between the pericardium and the diaphragm, which can often be obscured due to fat, swelling, inflammation, and scarring. Once a part of the pericardium is detached from the heart muscle, it can be removed, making the remaining part to be removed more visible.

In simpler terms, this surgery is like removing a tight, rigid jacket from around the heart that’s causing it to malfunction. The tutorial provides advice to help surgeons perform this complex procedure more easily.

FAQs

  1. What is chronic constrictive pericarditis and what are its effects?
  2. What is the standard surgical treatment for chronic constrictive pericarditis?
  3. What are the steps involved in a pericardiectomy procedure?

Doctor’s Tip

One helpful tip a doctor might give a patient about pericardiectomy is to follow post-operative care instructions carefully, including taking prescribed medications, attending follow-up appointments, and avoiding strenuous activities until cleared by the surgeon. It is important to communicate any concerns or symptoms to the healthcare team to ensure a smooth recovery process.

Suitable For

Patients who are typically recommended for pericardiectomy are those with chronic constrictive pericarditis that has led to impairment of diastolic filling and right heart failure. These patients may have symptoms such as dyspnea, fatigue, edema, and ascites. Pericardiectomy is considered the mandatory treatment for these patients as the disease is irreversible. The standard surgical technique involves the complete removal of the anterior pericardium, diaphragmatic pericardium, and part of the pericardium posterior to both phrenic nerves. Patients who do not respond to medical management or have severe symptoms may be candidates for pericardiectomy.

Timeline

Before pericardiectomy:

  1. Patient presents with symptoms such as shortness of breath, chest pain, fatigue, and swelling in the legs.
  2. Diagnosis of chronic constrictive pericarditis is made through imaging tests such as echocardiogram, MRI, or CT scan.
  3. Patient undergoes pre-operative evaluation and preparation for surgery.

After pericardiectomy:

  1. Patient undergoes pericardiectomy surgery through a median sternotomy.
  2. The anterior pericardium is completely removed from phrenic nerve to phrenic nerve, along with part of the diaphragmatic pericardium and posterior pericardium.
  3. The pericardial rigid shell is separated from the pleurae and diaphragm to clearly visualize the phrenic nerves and boundaries.
  4. Excision of the pericardium allows for improved diastolic filling and relief of symptoms.
  5. Patient undergoes post-operative care and recovery, including monitoring for complications such as bleeding, infection, or arrhythmias.
  6. Patient experiences improvement in symptoms such as increased exercise tolerance and reduced swelling in the legs.

What to Ask Your Doctor

  1. What is the success rate of pericardiectomy in treating chronic constrictive pericarditis?
  2. What are the potential risks and complications associated with pericardiectomy surgery?
  3. How long is the recovery process after undergoing a pericardiectomy?
  4. Will I need to take any medications or undergo additional treatments after the surgery?
  5. Are there any lifestyle changes or restrictions I should be aware of following a pericardiectomy?
  6. How often will I need to follow up with you or a cardiologist after the surgery?
  7. Are there any alternative treatments or procedures available for chronic constrictive pericarditis?
  8. What symptoms should I watch out for that may indicate a complication after the surgery?
  9. How long do the effects of pericardiectomy typically last?
  10. Are there any long-term implications or risks associated with undergoing a pericardiectomy procedure?

Reference

Authors: Di Lazzaro D, Di Bella I, Pasquino S, Berti V, Da Col U. Journal: Multimed Man Cardiothorac Surg. 2020 Dec 22;2020. doi: 10.1510/mmcts.2020.076. PMID: 33399281