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The recommendation of surgery for Pericarditis is a judgment call made by the doctor on a case by case basis. Depending on your overall health, the procedure is relatively safe.
Sometimes surgery is necessary when fluid builds up in the pericardium and causes compression. In this case, you may need to undergo pericardiocentesis – which is a procedure that drains the excess fluid with a catheter.
The doctor will use echocardiography to safely guide the placement of a large needle and catheter into the pericardium to remove excess fluid. If the fluid cannot be drained with a needle, a surgical procedure called a pericardial window is performed.
A pericardial window is surgery for pericarditis, usually reserved for the presence of a pericardial effusion (fluid around the heart between the pericardium and the heart). If there is concern for cardiac constriction, the entire pericardial sac must be removed.
Repeated inflammation build-up mixed with periods of no inflammation in patients with pericarditis can lead to a stiffening of the pericardial sac, constricting the heart and giving it limited room to work properly.
The type of surgery for pericarditis performed is generally based on the results of the echocardiogram, which can detect excess fluid in the space between the layers of the pericardium, and the electrocardiogram (ECG). Surgery is rarely performed for pain control of recurrent pericarditis. If a window is performed and the pericarditis keeps coming back, patients may eventually need a pericardial stripping as well.
What Is Pericardial Stripping?
Pericardial stripping is a much more complicated procedure, involving a large incision and a higher post-operative risk of infection, discomfort and bleeding. In most cases, there are no other surgical options. The patient is not at a higher risk of infection due to the stripping (removal of the pericardial sac) itself, but rather from the surgery in general. As soon as the patient has healed, their risk of infection decreases.
Some patients with constrictive pericarditis may also require surgery – most commonly a pericardiectomy – which is the surgical treatment of pericarditis involving the removal of a portion of the pericardium.
“After the removal of the pericardium, you will not have recurrent problems. The lining of your lungs (pleura) are a similar tissue and may be at risk for inflammation in the future. Doctors are currently uncertain as to why the pericardial sac is there at all. People have been born without a pericardial sac, and have not developed any complications due to its absence”
What Is The Outlook After Surgery For Pericarditis?
In most cases, pericarditis persists for up to three months and then goes away without returning.
After you recover from the illness, you should be able to return to your normal activities without any complications. Your doctor will talk to you about what you can expect, as well as any limitations based on your age, health, activity level and the cause of your pericarditis.
In some cases of surgery for pericarditis, the pericardial attacks recur every few months and anti-inflammatory medications are needed for years to manage symptoms.