What Is a Pericardiectomy?

Pericardial resection is a surgical method for the treatment of constrictive pericarditis. After the diagnosis of constrictive pericarditis, pericardectomy should be performed as soon as possible, even if there is still some pus and fluid in the pericardial cavity, and the fiber board is not completely formed. Narrowing has impeded heart function, and early surgery to relieve compression is better than delaying until the fiber board is fully formed before surgery.

Pericardial resection

1. Cardiac arrest is prone to occur during the induction of anesthesia. It is required to be stable and avoid hypoxia. Intubation should be performed quickly and artificial respiration should be performed in time to avoid hypotension during anesthesia and surgery. It should be ensured that hypoxemia does not occur during the operation. In addition to ECG monitoring, blood gas analysis monitoring is also required.

2. It is inevitable to compress the heart when the pericardium is peeled off. To avoid prolonged compression, if frequent premature beats occur, the operation should be suspended to avoid severe heart rhythm disturbance.

3. When the calcification is severe and multiple peeling is difficult, multiple # -shaped incisions can be used to remove only the part that may be removed, leaving the non-peelable part in an island shape on the myocardium. Do not blindly pursue complete removal.

4. When pus is found in some pericardial cavity, or a layer of unorganized granulation is attached to the surface of the heart, pus, necrosis should be removed, and granulation tissue should be removed as patiently as possible; stripping can also be taken to avoid future The granulation tissue is mechanized to form new constrictions.

5. The atrioventricular sulcus should be fully released. If it is impossible to completely remove it, it should also be intermittently released to prevent the interventricular passage from being blocked, but it should be handled carefully to avoid damage to the coronary vessels. No conventional stripping is performed at the entrance of the upper and lower cavities unless there is evidence of compression. The upper cavity is rarely compressed. The fiber ring at the entrance of the inferior cavity can be probed into the fiber ring to protect the inferior vena cava, and the fiber ring is peeled off sharply, and then it is cut to release the pressure on the inferior vena cava. Remove the fiberboard.

6. Proper amount of blood loss should be added during the operation to avoid overdose. Fluid input should be strictly restricted to avoid excessive fluid load and cause left heart failure.

1. Cardiac treatment can be started after cardiomyopathy treatment

Surgery process diagram (6 photos)

Later, digoxin can be taken orally to prevent left heart failure.

2. Diuretic constrictive pericarditis patients often have water retention in their bodies. Therefore, diuresis is needed after surgery to reduce the burden on the heart.

3. Sodium input should be strictly restricted after maintaining electrolyte balance unless low sodium is proven. Those with high urine volume need potassium supplements to avoid hypokalemia.

4. Maintain the negative balance of water After the operation, maintain the negative balance of water until the patient has a weight loss appearance or edema and ascites disappear completely, and the liver shrinks.

5. Hormonal therapy. Those who had had regular hormonal therapy for more than two weeks before surgery needed hormonal therapy during the operation and early postoperative period, which lasted until 3 to 4 days after the operation.

6. The left ventricular function of the patient should be observed after vasodilators. If left ventricular dysfunction is present, vasodilators can be used at the same time as cardiotonics and diuretics to reduce postload and relieve left ventricular burden. Recovery of heart function.

7. Those who proved to be tuberculous constrictive pericarditis should be treated with antituberculosis for 1 year after operation.