pericardiectomy

Pericardiectomy is a surgical procedure to remove part or all of the pericardium, the sac encasing the heart, in order to relieve constriction and improve diastolic filling. The operation is most commonly performed to treat constrictive pericarditis, a condition in which scar tissue and thickened pericardium restrict the heart’s ability to fill properly. It may be used in selected cases of effusive-constrictive pericarditis where constriction persists after drainage of fluid.

Preoperative evaluation typically includes echocardiography to assess cardiac filling and hemodynamics, along with computed tomography or magnetic resonance imaging to delineate pericardial thickening or calcification. Etiologies such as tuberculosis, prior cardiac surgery, or radiation exposure may be identified and treated when possible. The procedure is usually carried out through a median sternotomy, with removal of the parietal pericardium over the ventricles; complete or radical pericardiectomy is often aimed for, though the extent may be limited by adhesions or proximity to vital structures. Cardiopulmonary bypass is used selectively, depending on the surgeon’s assessment and intraoperative hemodynamics.

Outcomes include sustained relief of symptoms such as dyspnea and edema in many patients, with improved diastolic filling. However, persistent symptoms can occur if residual constriction remains or if there is underlying restrictive cardiomyopathy. Operative mortality and morbidity vary by center and patient factors but are generally higher than for many other cardiac surgeries, underscoring the need for experienced surgical teams and careful patient selection. Postoperative care involves intensive monitoring, management of hemodynamics, and gradual rehabilitation.