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 Pericarditis is basically an inflammation of the pericardium. The pericardium is a double-walled sac which covers the heart and the roots of the great vessels (the four large vessels that supply blood to, and from the heart). When Pericarditis occurs, the outer layer of the heart (the membrane) appears red and enlarged or swollen.

Though Pericarditis is a serious condition which needs to be treated immediately, it can be treated with medication alone and surgery is normally not required. Many Pericarditis cases recover with rest alone. Pericarditis mostly continues for three months, after which it gets fully cured and does not relapse. But, sometimes the problem persists, recurring every few months. In such a case, anti-inflammatory drugs may need to be taken for several years in order to manage it.

After recovery, most patients are able to return to their daily routine and day-today activities, after consulting the doctor. Depending on the age of the patient and other factors, the doctor will advise the patient about restrictions, if any. Surgery is required only if there are other problems such as, Cardiac Tamponade, which is a life threatening complication of Pericarditis.

When Cardiac Tamponade occurs, fluid accumulates in the area between the sac and the heart muscles. This is usually surgically corrected by a procedure called Pericardiocentesis. The other condition in which surgery is needed is Constrictive Pericarditis, another severe and chronic complication of Pericarditis. When this occurs, the pericardium’s inflamed layers will harden or thicken, develop scar tissue and stick together thereby severely obstructing the normal functioning of the heart. Constrictive pericarditis is corrected by undergoing Pericardiectomy.    

Sometimes Pericardiectomy is also recommended for severe and constantly recurring Pericarditis.

Pericardiocentesis: This surgery involves draining out all the excess fluid from the pericardial space (also called pericardial cavity). This is done with the help of a sterile, surgical needle or with the help of a catheter (a tiny tube). General anesthesia is not required for this surgery. The patient will receive local anesthesia, generally done along with echocardiogram monitoring and ultrasound. Sometimes the catheter is left there so that it can keep draining out the fluid over a period of some hours or days.

All anti-inflammatory medicines like ibuprofen, which the patient may have been taking to treat Pericarditis, will be stopped one week before the surgery. Blood thinners including aspirin will also be stopped. This is done to minimize chances of excessive bleeding.

People with diabetes, are advised to consult the doctor about the medications.

Postoperative Care after Returning Home:

The following steps may be advised by the doctor for smooth and quick recovery.

• The area where the needle was inserted should be cleaned gently with mild soap and lukewarm water. This process should be very gentle and the area should not be scrubbed harshly.
• Vigorous activities which are likely to stress the body, especially the upper part of the body, should be avoided at all costs. They should be resumed only after consultation with the doctor.
• Obesity, smoking and drinking may aggravate the complication. It is best to avoid saturated fat, oily food, alcohol and cigarettes

A follow-up examination must be conducted and the doctor should be notified immediately if any of the below mentioned symptoms occur.

• Signs of infection
• Fever and chills
• Redness or swelling of the operated area
• Increasing pain, which cannot be controlled even with medication
• Excessive bleeding or discharge from the area
• Cough or difficulty in breathing
• Nausea, Vomiting or Dizziness
  

Pericardiectomy: In this surgery the pericardium or a part of the pericardium is removed.

References:

1. http://www.bermudahospitals.bm/health-wellness/MedicalProcedures.asp?chunkiid=102884
2. http://cardiac.surgery.ucsf.edu/conditons--procedures/pericarditis.aspx

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