Let's learn simply about Pericardiectomy (surgery to remove the membrane around the heart).

Our heart is like a precious treasure, isn't it? So nature has created something wonderful to protect that treasure. That is a thin membrane that surrounds the heart. But sometimes this very protection can cause trouble for the heart. At such times, this membrane has to be removed surgically. That is what we are talking about today.

What exactly is a pericardiectomy?

Simply put, a pericardiectomy is the surgical removal of all or part of the pericardium , the membrane that surrounds your heart. This is sometimes called “pericardial stripping.”

Think about it, this pericardium is like a two-membrane sac that houses the heart. There is a very small amount of fluid between these two membranes. It is that fluid that helps the heart beat smoothly and without any friction.

Can we live without this pericardium?

Yes, it is definitely possible. The pericardium itself is not essential for the normal functioning of the heart. If your lungs and the diaphragm, the muscle that separates your chest and abdomen, are in good condition, there will be no problem with removing the pericardium.

In fact, when someone develops pericarditis, the pericardium loses its smoothness, which means its ability to reduce friction. So removing it doesn't make the situation worse.

What are the reasons for performing a pericardiectomy?

The main and most common reason for this surgery is a condition called Constrictive Pericarditis . This is when the membrane surrounding the heart becomes thick, stiff, and sometimes has calcium deposits that make it hard like a stone.

Imagine what happens when the sac around the heart suddenly tightens.

• The heart is pulled tightly and unable to contract.
• Therefore, the heart chambers do not fill with enough blood.
• The blood coming to the heart is forced back towards the lungs.
• The heart is unable to pump blood normally.
• This causes the legs and abdomen to swell, which is similar to symptoms of heart failure.

This surgery is the best solution for the most severe cases of Constrictive Pericarditis.

Causes of Constrictive Pericarditis

• Idiopathic: In most cases, no specific cause can be found.
• Previous heart surgery: It may be due to a previous surgery.
• Radiation therapy to the chest: Radiation therapy to the chest area for conditions such as cancer.
• Diseases such as Tuberculosis: This can be caused by certain medical conditions.
• Viral or bacterial infections: This can also be caused by certain infectious conditions.

In addition, this surgery is performed in several other cases:

• Recurrent Pericarditis: If this condition continues to occur despite medication.
• Side effects of anti-inflammatory drugs: If complications occur due to drugs such as steroids given to control pericardial tightness.
• Cardiac Tamponade: Very rarely, this is also done when fluid accumulates around the heart and compresses it.

What happens before and during surgery?

Before surgery

Your medical team will prepare all the necessary equipment to perform the surgery safely. Often, the surgeon will use a cardiopulmonary bypass machine , also known as a heart-lung machine. This machine temporarily takes over the work of the heart and lungs during the surgery. This allows the doctor to safely remove the pericardium from both sides and behind the heart.

During surgery

1. Making the incision: The doctor makes an incision in the middle of your chest, along the breastbone (sternum), to reach the heart. This is called a Median Sternotomy .

2. Removal of the pericardium: The pericardial membrane is carefully removed from the heart.

3. Fixing the sternum: The sternum is fixed again using wires.

4. Stitching the incision: Finally, the incision is closed with stitches.

This surgery usually takes about two to three hours, but this time may vary if other procedures are being performed at the same time.

What happens after the surgery?

You will feel some pain when you wake up after the surgery. You will also have one or more tubes (drains) placed in your chest to drain excess fluid. You will be able to drink fluids from the day after surgery and then gradually eat food. You may need to continue taking diuretics, although at a lower dose than you were taking before surgery.

What are the benefits and risks of this surgery?

As with any major surgery, there are benefits and risks. Choosing an experienced cardiac surgeon can minimize the risks.

People who have had previous heart surgery, have other major medical conditions, or have received radiation therapy are at slightly higher risk of complications.

How long does it take to recover?

You usually have to stay in the hospital for about five to seven days. After you go home, you can avoid lifting heavy objects and gradually resume other normal activities.

It takes between 6 and 8 weeks to fully recover. This time can vary depending on how bad your condition was before surgery. It may take longer for people who are in the worst condition. However, most people feel immediate relief after surgery.

When should you see your doctor again?

You will need to see your cardiologist within a week or two after leaving the hospital. You will also need to have an echocardiogram (ultrasound scan of the heart) six weeks after surgery.

Tell your doctor immediately if the following symptoms occur:

• Chest pain
• Fever
• If there is more fluid than usual draining from the surgical wound

Pericardiectomy, Pericardiocentesis and Pericardiotomy - What's the difference?

These three names are a bit similar, so it can be confusing. Let's see what the difference is.