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


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.
 * 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


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


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.

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