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The pericardium is the sac in which the heart is located, it performs a protective and regulatory function. Pathologies in this part lead to impaired blood supply to the heart, purulent abscesses, fibrous adhesions. This condition is very life-threatening, it is important to identify and cure it in time. The most effective method of treatment today is considered pericardiectomy. This is a surgical operation during which all or part of the pericardium is removed.
Description of the procedure
Excision of diseased parts of the pericardium is necessary for dangerous pathologies in this area. Depending on the situation, either the entire bag is removed, or only the affected areas. If they get rid of the whole – this is called subtotal pericardectomy, if only a part is removed – this is the Rena-Delorme operation. Most often you have to do the first to avoid further obstruction. Both the one and the other version of the operation refers to complex surgical procedures, the patient is carefully examined before the procedure, they are monitored after it.
The main indications for pericardectomy are: exudative and constrictive pericarditis. These are the conditions in which exudate is formed in the pericardial cavity, blood or fluid accumulates.
As a result, blood flow to the heart is disrupted, adhesions form, and the risk of death from a myocardial infarction or heart attack increases. Symptoms that may indicate pericarditis: violations of blood pressure (it can either increase or decrease greatly, difficulty in breathing, as a rule, it is severe shortness of breath), disturbed heart rhythm – tachycardia or, conversely, too slow pulse, constant pain and heaviness in the chest. During the operation, the heart sac is cleaned, fibrous formations, calcified parts are removed. If it is impossible to save the pericardium, it is excised completely, leaving only the posterior wall. The patient after such an intervention requires constant supervision of doctors, there is a recovery period.
Preparation of the patient
Given the complexity and risks of such manipulations, doctors conduct diagnostics before prescribing an operation. There must be good reasons for pericardectomy, so first they try to accurately establish the diagnosis and exclude contraindications. If exudate accumulates in the pericardial cavity, a pericardial puncture may be performed to establish the nature of the accumulating mass and remove the exudate. A few days before surgery, the patient is prescribed diuretics and drugs to support the cardiovascular system.
It is also forbidden to take alcohol 5-7 days before the procedure, it is highly recommended to stop smoking or at least reduce it to a minimum. Nutrition is an important part of preparation. Based on clinical indicators, the doctor makes a diet for his ward, aimed at supporting the heart, not overloading the gastrointestinal tract. On the eve of the operation, the doctor may ask you to remove hair from the chest area, if necessary.
Contraindications for pericardectomy
Such intervention refers to risky and very complex invasions. It requires a lot of experience from the doctor and a thorough examination of the patient. It is important to make sure that there are no contraindications. The operation is not performed if a person has:
- myocardial fibrosis – increases the risk of complications and fatal outcome of the procedure;
- lime deposits in the pericardial cavity – it is formed, as a rule, after adhesive or effusion pericarditis;
- mild form of constipative pericarditis.
Before the operation, the doctor evaluates all the risks and decides on the surgical intervention. The success of the procedure is influenced by the age of the operated person, excess weight, impaired kidney or lung function. If it is impossible for a patient to undergo a pericardectomy, other options are being sought to alleviate well-being and save a life.
Method of conducting
The procedure will take place under general anesthesia, so for the patient everything will be quick and painless. On the day of the pericardectomy, shower and change into the sterile clothing provided. As a rule, the patient is first placed in the preoperative room, where anesthesia is performed. Sometimes it is carried out immediately in the operating room. Most often, the patient is connected to an artificial respiration apparatus. Be sure to connect the equipment to monitor the heartbeat and pressure. After anesthesia is carried out, the cardiac surgeon proceeds with the following actions:
- An incision is made in the chest, the access site is selected at the time of diagnosis.
- Then a small incision is made in the pericardium. The surgeon must find the point of dissection of the epicardium and pericardium. The edges of the incised zone are grasped with tools and the pericardium is separated.
- In the region of the atria, coronary vessels and vena cava, the process is difficult, since the walls here are very thin.
- After excision of the desired area or the entire pericardium, the remaining edges are sutured to the edges of the sternum and intercostal muscles.
- The dissection area is sutured in layers. External seams are treated with antiseptic agents, a bandage is applied.
If there is exudate in the area of the heart bag, the doctor installs a drainage catheter through which fluid will exit for another 1-2 days. During the entire process, there will be an anesthesiologist and surgical assistants in the operating room.
The patient’s condition is monitored with the help of equipment. The procedure lasts at least two hours, sometimes four hours.
After the operation, the patient is transferred to the intensive care unit, and when he comes to his senses, to the intensive care unit. In the first days after this, doctors constantly monitor the work of the heart and blood pressure.
Recovery after surgery
For pericardectomy, the patient remains in the hospital for at least a week. After the operation, he spends another 4-5 days under the supervision of doctors. On the first day, bed rest is indicated, then the patient’s activity depends on his condition. Observations are needed in order to prevent complications and negative consequences. Among the complications there are increased cardiovascular insufficiency, bleeding into the pleural cavity, anuria and uremia, purulent mediastinitis, infection. To prevent infections and purulent processes, the patient is prescribed antibiotics. Pain medications are needed in the first half of the recovery period.
The patient should discuss any medications that he plans to take with the doctor. After 7-14 days, a series of examinations may be ordered to check the effectiveness of the pericardectomy. Over the next month, the patient should regularly visit his doctor, undergo an examination, follow all the recommendations of the cardiologist.
Improvement in well-being is predicted within the first 3-4 weeks. Restoration of blood flow and vascular functions fully occurs in 5-6 months.
The Renat-Delorme operation is considered simpler and less dangerous. With subtotal pericardectomy, mortality is recorded in 5-8% of cases.
In general, the operation is carried out with a positive prognosis, today it is practically the only way to save a person with chronic exudative or constrictive pericarditis. Most patients fully recover and return to normal life six months after surgery, even after complete removal of the pericardium.