Surgery for Pericarditis

Introduction

Pericarditis is an inflammation of the pericardium, the thin sac surrounding the heart. Most cases are treated with medications, but in severe or recurrent cases, surgical intervention may be necessary.

Indications for Surgery

Surgery is considered when: - Recurrent pericarditis: Cases that do not respond to long-term medical therapy. - Constrictive pericarditis: When the pericardium becomes thick and rigid, restricting heart function. - Cardiac tamponade: A life-threatening condition where fluid accumulates rapidly around the heart. - Purulent (infectious) pericarditis: Bacterial infections may require surgical drainage.

Types of Surgical Intervention

  1. Pericardiocentesis
    • A minimally invasive procedure to drain excess fluid from the pericardial sac using a needle or catheter.
    • Used in cases of cardiac tamponade.
  2. Pericardiectomy
    • Surgical removal of part or all of the pericardium.
    • Indicated for constrictive pericarditis or severe recurrent pericarditis.
  3. Pericardial Window
    • A small portion of the pericardium is removed to allow continuous drainage.
    • Used mainly to prevent recurrent effusions.

Risks and Prognosis

While surgery is generally safe, risks include: - Infection - Bleeding - Arrhythmias - Damage to surrounding cardiac structures The prognosis depends on the underlying cause and the patient's overall health. Pericardiectomy has good long-term results, especially in constrictive pericarditis.

Conclusion

Surgical intervention is reserved for severe or refractory pericarditis. Proper diagnosis and early intervention improve outcomes significantly.

Source recommendations

1. 2022 ESC Guidelines for the Diagnosis and Management of Pericardial Diseases

  1. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Pericardial-Diseases-Guidelines-on-the-Diagnosis-and-Management-of
  2. https://pubmed.ncbi.nlm.nih.gov/26320112/
  3. https://www.escardio.org/Councils/Council-for-Cardiology-Practice-(CCP)/Cardiopractice/tip-and-tricks-for-acute-pericarditis
  4. https://academic.oup.com/eurheartj/pages/esc_guidelines
  5. https://www.acc.org/Latest-in-Cardiology/Articles/2022/12/19/14/52/The-Paradigm-Shift-in-the-Management-of-Recurrent-Pericarditis

2. AHA/ACC Guidelines for the Management of Pericardial Diseases

  1. https://www.ahajournals.org/doi/10.1161/circulationaha.105.561514
  2. https://www.jacc.org/doi/10.1016/j.jacc.2019.11.021
  3. https://www.sciencedirect.com/science/article/abs/pii/S1936878X24001608
  4. https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2020/01/07/10/59/Management-of-Acute-and-Recurrent-Pericarditis
  5. https://pubmed.ncbi.nlm.nih.gov/33332149/

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