What is a Pericardiectomy?
Pericardiectomy is the removal of the pericardium (heart’s sac). This is major surgery and is performed via a thoracotomy (opening the chest between the ribs). A pericardiectomy is indicated when there is recurrent haemorrhage into the pericardial sac or when the pericardium becomes fibrosed (thickened and restrictive) resulting in constriction of the heart. The heart is then unable to pump and circulate blood normally, leading to symptoms of heart failure. The role of the pericardial sac is minor and a dog can live without it.
What does the operation involve?
Nearly all cases of pericardial disease in dogs are due to either idiopathic pericarditis (inflammation of the pericardium) or the presence of a tumour. Pericardiectomy is indicated for recurrent pericarditis, pericardial fibrosis or slow growing heart base tumours. It is not indicated when the cause is a highly malignant tumour.
The purpose of pericardiectomy is to remove as much of the inflamed pericardium as possible – this means the pericardial sac no longer constricts the heart and it removes much of the source of the haemorrhage. During surgery, the heart can be visually examined to double check for a tumour that may not have been detected on ultrasound.
What is the prognosis (outlook)?
Pericardiectomy has a success rate of approximately 80 to 90% – resulting in a resolution of the symptoms for many years. However complications can occur – the most common is continuing haemorrhage leading to inflammation of the chest cavity resulting in breathlessness. The mortality rate, during or after surgery, is considered low (< 5%). For best results, the procedure should be performed by a veterinary surgeon experienced in this surgery. In our opinion, intravenous fluids prior to surgery and for at least 24 hours post-operatively, reduces the risk of thromboembolism and thus reduces the mortality risk.
Before recommending pericardiectomy our cardiologist will perform a thorough ultrasound examination of the heart (ideally before and after drainage of the haemorrhage from the pericardial sac). Radiographs of the lungs and ultrasound examination of the abdomen is sometimes also useful to check for other evidence of malignancy.
What is the aftercare following a percardiectomy?
Most patients are able to return home within 2 to 5 days, although each individual patient recovers differently. Your pet will return home wearing a chest bandage to protect the wound until suture removal. Please keep the bandage clean and dry to protect the surgery site. Ensure your pet receives the daily antibiotics provided. Your pet should be kept very quiet until suture removal 10 to 12 days after surgery (by your own vet). Following this, exercise must be restricted for another 3 to 4 weeks, after which there can be a gradual return to normal exercise.
If you have any queries or concerns, please do not hesitate to contact us.