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Pericardiotomy – Surgical Procedure on the Pericardium

A pericardiotomy is a surgical procedure in which the pericardium – the fibrous sac surrounding the heart – is incised. It is used to drain fluid or as part of open-heart surgery.

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Things worth knowing about "Pericardiотomy"

A pericardiotomy is a surgical procedure in which the pericardium – the fibrous sac surrounding the heart – is incised. It is used to drain fluid or as part of open-heart surgery.

What is a Pericardiotomy?

A pericardiotomy is a surgical procedure in which the pericardium – the tough, double-layered fibrous sac enclosing the heart – is incised (cut open). The term derives from the Greek words perikardion (pericardium) and tome (incision). The procedure may be performed as a standalone intervention or as part of a more extensive cardiac surgical operation.

Indications

A pericardiotomy is performed in a variety of clinical situations, including:

Pericardial effusion: Abnormal accumulation of fluid within the pericardial sac that impairs cardiac function
Cardiac tamponade: Life-threatening compression of the heart due to excessive fluid in the pericardium
Purulent pericarditis: Bacterial infection of the pericardium resulting in pus accumulation
Preparation for cardiac surgery: Such as coronary artery bypass grafting or heart valve replacement
Postoperative pericardial effusion syndrome: Fluid accumulation following cardiac surgery

Surgical Approaches

The pericardiotomy can be performed using several approaches, depending on the clinical scenario and the extent of the procedure required:

Subxiphoid Pericardiotomy

In this approach, the incision is made below the xiphoid process of the sternum. It is a minimally invasive technique particularly suited for draining a pericardial effusion or relieving cardiac tamponade. The procedure can be performed under local or general anesthesia.

Transthoracic Pericardiotomy

This approach involves opening the pericardium through an incision between the ribs (intercostal space). It provides better visualization of the operative field and is often preferred for more extensive procedures.

Pericardiotomy via Sternotomy

In open-heart surgery, the pericardium is opened following a sternotomy (division of the sternum), allowing complete access to the heart and surrounding structures.

Procedure and Postoperative Care

Before the procedure, imaging studies such as echocardiography or computed tomography (CT) are performed to assess the extent of the pericardial effusion. During the procedure, the drained fluid is routinely sent for laboratory analysis to determine the underlying cause of the effusion. A drain is often left in place after the procedure to prevent re-accumulation of fluid. Postoperative care includes regular echocardiographic follow-up and, depending on the underlying condition, appropriate medical therapy.

Risks and Complications

As with any surgical procedure, pericardiotomy carries potential risks and complications:

Bleeding or hematoma formation at the surgical site
Wound or pericardial infection
Injury to adjacent structures (e.g., lung, diaphragm, coronary vessels)
Cardiac arrhythmias
Recurrent effusion (re-accumulation of fluid)
Pneumothorax (air accumulation in the chest cavity)

Distinction from Pericardiectomy and Pericardiocentesis

The pericardiotomy should be distinguished from related procedures: A pericardiectomy involves complete or partial surgical removal of the pericardium, which may be indicated in chronic constrictive pericarditis. Pericardiocentesis, on the other hand, is a non-surgical, percutaneous technique in which fluid is withdrawn from the pericardial sac using a needle – without any surgical incision.

References

Maisch B. et al. – Guidelines on the Diagnosis and Management of Pericardial Diseases. European Heart Journal, 2004; 25(7): 587–610.
Imazio M. et al. – Pericardial diseases: clinical-pathophysiological spectrum. Heart, 2015; 101(12): 923–930.
Cohn LH (ed.) – Cardiac Surgery in the Adult. McGraw-Hill Medical, 4th edition, 2012.

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