Tuberculous pericarditis pericardiectomy


 * Associate Editor-In-Chief: Varun Kumar, M.B.B.S.; Lakshmi Gopalakrishnan, M.B.B.S.

Pericardiectomy
Pericardiectomy is the surgical removal of the pericardium. It may be adopted in treatment of recurrent pericardial efussion due to TB, in tuberculous constrictive pericarditis or if there is no hemodynamic and general improvement after 4-8 weeks following antituberculosis chemotherapy. If it is performed in the early stages of TB pericardial constriction, pericardiectomy has a low mortality rate when compared to advanced stages of the disease where pericardiectomy is poorly tolerated. Mortality rate secondary to this procedure is 3-16%. This surgery should be undertaken under the coverage of antitubercular drugs.

Treatment of effusive constrictive pericarditis is challenging because pericardiocentesis does not relieve the impaired filling of the heart, and surgical removal of the fibrinous exudate coating the visceral pericardium may not be possible. Patients should be started on antitubercular drugs and serial echocardiography should be performed to monitor the changes of pericardium and to make a decision regarding its surgical stripping.