Pericardiectomy
What is Pericardiectomy ?
.
Why do you need Pericardiectomy ?
The pericardium can become thickened, scarred, or calcified due to chronic inflammation, leading to constrictive pericarditis, where the heart is restricted from expanding fully. Pericardiectomy is indicated for:
- Constrictive pericarditis: Caused by infections (e.g., tuberculosis), radiation therapy, cardiac surgery, or idiopathic factors, resulting in symptoms like shortness of breath, fatigue, and swelling.
- Recurrent pericardial effusion: Repeated fluid buildup despite drainage (e.g., due to cancer or infection).
- Pericardial tumors or cysts: Rare cases requiring removal of the pericardium.
Why Do Pericardiectomy Costs Vary in Philippines?
.
Pericardiectomy Procedure
The procedure is tailored to the patient’s condition, extent of pericardial involvement, and underlying cause:
- Before Surgery Evaluation:
- Diagnosis is confirmed via imaging, including echocardiogram (showing restricted heart motion), CT scan, or MRI (revealing pericardial thickening or calcification).
- Cardiac catheterization may assess heart pressures to confirm constrictive physiology.
- Blood tests evaluate infection (e.g., TB), kidney function, or malignancy.
- Pulmonary function tests and ECG ensure surgical fitness, especially in patients with comorbidities.
- Surgical Techniques:
- Open Pericardiectomy:
- Performed under general anesthesia, lasting 2–4 hours.
- A median sternotomy (chest bone incision) or left thoracotomy (side chest incision) provides access to the pericardium.
- The surgeon removes the thickened or scarred pericardium, typically starting with the anterior and lateral portions, while preserving the phrenic nerves to maintain diaphragm function.
- In severe cases (e.g., extensive calcification), a total pericardiectomy is performed, though partial removal is often sufficient.
- Chest tubes are placed to drain fluid and prevent post-surgical complications.
- Minimally Invasive Pericardiectomy:
- Rarely used, involving smaller incisions and thoracoscopic assistance for less extensive disease.
- Suitable for select patients with localized pericardial involvement, offering reduced recovery time but limited applicability due to technical challenges.
- Pericardial Window (Adjunct or Alternative):
- In cases of recurrent effusion, a small portion of the pericardium is removed to allow fluid drainage into the chest cavity, sometimes performed instead of full pericardiectomy.
- Open Pericardiectomy:
- After Surgery:
- Patients are monitored in the ICU for 1–3 days to manage pain, heart function, and chest tubes.
- Hospital stay lasts 5–10 days, depending on the extent of surgery and complications.
- Pathology analysis of the pericardium identifies underlying causes (e.g., TB, malignancy), guiding further treatment.
- Follow-up imaging (echocardiogram, CT) ensures improved heart function and no fluid reaccumulation.
Recovery After Pericardiectomy
Recovery depends on the surgical approach, patient’s health, and underlying cause:
- Hospital Stay:
- Open pericardiectomy requires 5–10 days, including 1–3 days in the ICU.
- Minimally invasive or pericardial window patients stay 3–5 days, with 1–2 days in the ICU.
- Post-Surgery Care:
- Pain at the incision site is managed with medications (e.g., paracetamol, opioids initially).
- Chest tubes are monitored for drainage, typically removed within 2–5 days.
- Patients are monitored for arrhythmias, infection, or fluid reaccumulation via ECG and echocardiograms.
- Medications address underlying causes (e.g., anti-TB drugs, steroids for inflammation).
- Activity and Diet:
- Light walking is encouraged within days to prevent blood clots and promote lung expansion.
- Strenuous activities, heavy lifting, or driving are avoided for 6–8 weeks (open surgery) or 3–4 weeks (minimally invasive).
- A balanced, low-sodium diet supports heart health, especially in patients with heart failure symptoms.
- Follow-Up:
- Follow-up visits at 1, 3, and 6 months include echocardiograms and CT scans to confirm improved heart function and no recurrence of constriction.
- Long-term management of underlying causes (e.g., TB, malignancy) is critical to prevent complications.
Most patients recover fully within 6–12 weeks, with significant relief from symptoms like shortness of breath and swelling. Success rates are 80–90% for symptom resolution, though outcomes depend on the underlying cause (e.g., better prognosis in TB-related cases than malignancy).
Risks and Complications
Pericardiectomy is a major surgery with potential risks:
- Surgical Risks:
- Bleeding or infection at the incision or chest tube site.
- Damage to the phrenic nerve, causing diaphragm dysfunction and breathing issues.
- Cardiac Complications:
- Arrhythmias or heart failure, particularly in patients with pre-existing heart damage.
- Rarely, injury to the heart or coronary arteries during surgery.
- Lung-Related Complications:
- Pneumonia or atelectasis (lung collapse), preventable with breathing exercises.
- Pleural effusion (fluid in the chest), requiring drainage.
- General Risks:
- Adverse reactions to anesthesia.
- Blood clots (deep vein thrombosis or pulmonary embolism), requiring anticoagulants.
- Long-Term Issues:
- Incomplete relief of constriction in advanced cases with myocardial involvement.
- Recurrence of effusion or constriction, especially in malignancy or untreated infections.
Prompt reporting of symptoms like fever, chest pain, or shortness of breath ensures timely management.
Frequently Asked Questions (FAQs)
What causes constrictive pericarditis requiring pericardiectomy?
Common causes include tuberculosis, viral or bacterial infections, radiation therapy, cardiac surgery, or idiopathic factors.
Is pericardiectomy the only treatment for constrictive pericarditis?
Mild cases may be managed with medications (e.g., anti-inflammatory drugs), but surgery is required for severe or symptomatic cases.
Can pericardiectomy be performed minimally invasively?
Minimally invasive pericardiectomy is possible for select cases but is less common due to technical challenges. Open surgery is the standard.
How soon can I resume normal activities?
Open surgery patients resume normal activities in 6–12 weeks; minimally invasive patients take 3–6 weeks.
Is pericardiectomy covered by insurance in India?
Most insurance plans cover pericardiectomy for medical necessity (e.g., constrictive pericarditis). Confirm with your provider.
What are the signs of complications post-pericardiectomy?
Fever, chest pain, shortness of breath, or swelling require immediate medical attention.
Can children undergo pericardiectomy?
Yes, children with constrictive pericarditis (e.g., from TB or infection) are treated in pediatric cardiac centers like Apollo Children’s Hospital.
How can I prevent complications after pericardiectomy?
Follow medical advice, complete treatment for underlying causes (e.g., TB therapy), practice breathing exercises, and avoid infections.
Conclusion
.
Looking for Best Hospitals for Pericardiectomy
Note: we are not promoting any hospitals
We do not promote any hospitals. All details are sourced from Google and hospital websites. Please verify independently. Start with your surgery—here’s the list of government, budget, and superspecialty hospitals accredited by the Department of Health (DOH), Philippine Health Insurance Corporation (PhilHealth), and Joint Commission International (JCI)
- click on your city and schedule your surgery now done in good hands.
| City | Minimum Price (₱) | Maximum Price (₱) |
|---|---|---|
|
Angeles City |
|
|
|
Antipolo |
|
|
|
Bacolod |
|
|
|
Bacoor |
|
|
|
Baguio |
|
|
|
Butuan |
|
|
|
Cagayan de Oro |
|
|
|
Caloocan |
|
|
|
Cebu City |
|
|
|
Dasmariñas |
|
|
|
Davao City |
|
|
|
General Santos |
|
|
|
General Trias |
|
|
|
Iligan |
|
|
|
Iloilo City |
|
|
|
Las Piñas |
|
|
|
Makati |
|
|
|
Malolos |
|
|
|
Manila |
|
|
|
Muntinlupa |
|
|
|
Parañaque |
|
|
|
Pasay |
|
|
|
Pasig |
|
|
|
Puerto Princesa |
|
|
|
Quezon City |
|
|
|
San Fernando |
|
|
|
San Jose del Monte |
|
|
|
Taguig |
|
|
|
Valenzuela |
|
|
|
Zamboanga City |
|
|
Disclaimer
This information is sourced from open platforms and is for general awareness only. Costs may vary based on individual cases. Please consult a qualified doctor for medical advice and explore options within your budget before deciding on the procedure.