Pericardial surgery

Cardiac surgery deals with the surgical treatment of pericardial diseases. The basic operations on the pericardium include:

Pericardiocentesis (pericardiocentesis).
Creating a pericardial window.
Pericardectomy.

Pericardiocentesis[edit | edit source]

It is a puncture pericardial to evacuate pericardial fluid.

In hospital conditions, it is performed under echocardiographic control, which minimizes complications and allows the subsequent introduction of a thin drain.^[1]
In the field, the pericardium is punctured sightlessly.
- The patient assumes a semi-sitting position.
- The epidural needle is inserted to the left of the xiphoid process at an angle of about 45 ° below the ribs towards the left nipple.
- We are approaching the heart with constant aspirations.
- We are waiting for a faint thud signaling the penetration of the pericardium and the subsequent aspiration of blood / serous fluid / air.
- After aspirating the blood, we inject a small amount of blood and see if it clots. Blood from the pericardial space does not contain fibrin and therefore does not clot.
- Exercise carries the risk of pericardial and cardiac laceration, coronary artery or lungs injury.
- The lethality of sightlessly pericardiocentesis is about 20 %.

Creating a pericardial window[edit | edit source]

This is a procedure during which we resect the pericardium and establish communication with the pleural cavity (thoracoscopically or from an anterolateral thoracotomy) or with the peritoneal cavity (from a short subxiphoidal incision). This procedure is most often performed in patients with malignant disease (metastases to the pericardium), where fluid accumulates in the pericardial space even after repeated punctures.

Perikardectomy[edit | edit source]

This is a complete removal of the pericardium (from an anterolateral thoracotomy or middle sternotomy). The indication for this procedure is constrictive pericarditis , the most common cause of which is tuberculosis or post-radiation pericarditidis.