Pericardiectomy is the surgical removal of part or most of the pericardium. This operation is most commonly done to relieve constrictive pericarditis or to remove a pericardium that is calcified and fibrous. There are many etiologies for constrictive pericarditis and it is better to know the exact cause as the post operative morbidity, mortality, and life expectancy are strongly influenced by the cause.
It takes place by removing the infected, fibrosed, or otherwise damaged pericardium. The procedure begins when the surgeon makes an incision in the skin over the breastbone and divides it to expose the pericardium. During the surgery, the surgeon will grasp the pericardium, cut the top of this fibrous covering of the heart, drop it into the specimen bag, and re-cover the heart. The breastbone is then wired back together and the incision is closed, completing the procedure. When the portion of pericardium lying between the two phrenic nerves is excised it is called total pericardiectomy. In cases where total pericardiectomy is not possible, subtotal pericardiectomy is performed or, in extreme cases, a cruciate incision on the pericardium is performed.
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