The pericardium surrounds the heart and protects it from infection and disease while lubricating and preventing friction while the heart pumps. In addition, the pericardium prevents the heart from over-expanding and keeps it functioning normally when blood volume increases. Constrictive pericarditis is a condition in which the pericardium becomes inflamed and causes scarring, thickening, and muscle tightening, or contracture of the heart. Other causes of cardiac constriction may lead to similar issues. If left untreated, they may lead to heart failure.

What may cause cardiac constrictions?

Particularly in the South African context, diseases such as HIV and Tuberculosis (TB) which make individuals more susceptible to viral and bacterial infections may bring about constrictive pericarditis or cardiac constriction. Other than infections, constrictive pericarditis may be caused by surgical complications of heart surgery, radiation therapy or tumours.

How is this procedure done?

Surgery for constrictive pericarditis is called a pericardiectomy, which is done under general anaesthesia by a cardiothoracic surgeon to remove a portion of the constricting pericardium. Under general anaesthesia, you may be connected to a heart-lung bypass machine which will take over the duties of the heart and lungs in supplying the body with oxygenated blood. Through open surgery, a large incision will be made in the chest to expose the heart, from which the surgery will be done.

Once the constricting pericardium has been removed, Dr Scott will then proceed to remove you off the heart-lung bypass machine, close the chest or smaller incisions with stitches and place a draining tube for recovery.

If the constricting tissue is a tumour, a biopsy may be done prior to surgery to test whether or not the tumour is malignant or benign. If benign the tumour may be removed through a similar surgery to the pericardiectomy explained above. If malignant, surgery will be discussed with you by both Dr Scott and your oncologist in which surgery may be done before or after other cancer treatments such as chemotherapy or radiation and may be done as an aggressive eradication of cancer or for palliative reasons.

What can I expect after surgery?

Waking up from surgery, you can expect a chest tube to be placed in your chest to drain any blood or fluid that may build up in the chest. You should have a catheter placed for urine for the next few days before you can get up and move around. You will be kept in the ICU for close observation of your heart, blood flow and fluid drainage for about 2 days. On a daily basis, you will receive oxygen therapy and be given compression stockings to wear on your legs as well. You will be moved from ICU to your hospital room where you will be advised to stay for a further 3 to 5 days before you may go home.

Your cardiothoracic surgeon will advise you on how to care for your incisions and how to treat the symptoms after surgery. Symptoms of swelling, muscle pain in the upper back and shoulders, fatigue, sleeping and appetite problems, constipation and chest pain near the chest bone are all normal after this type of surgery. Patients with severe pericardial constriction should feel an immediate improvement after surgery, while others may feel better heart functioning once fully recovered.

It may take anything from 6-8 weeks for a full recovery, and Dr Scott will be able to tell you when you may begin physical activity. You will be instructed to walk regularly and slowly increase your activity, as well as how to do breathing exercises to aid recovery. Patients are usually able to return to work at 6 weeks post-operation depending on the physical demand of their type of work. You will be asked to come for an echocardiogram after recovered so your cardiothoracic surgeon may ensure that your heart is pumping as it should be.

If surgery was done for a constricting malignant tumour, in conjunction with your oncologist, he would discuss the outcome of the surgery and the process of further treatments such as chemotherapy or radiation. Whether malignant or benign, Dr Scott aims to aid his patients in managing the pain and discomfort that may occur following this surgery.