Pericardiectomy is the removal of most of the pericardium, or heart sac (see www.heartydog.co.uk). This is major chest surgery and is performed via a thoracotomy (opening the chest between the ribs). The role of the pericardial sac is minor and a dog can live without it.
A pericardiectomy is indicated when there is recurrent
build up of fluid
in the pericardial sac or when the pericardium becomes fibrosed (thickened and restrictive) resulting in constriction of the heart. The heart becomes unable to pump and circulate blood normally, leading to symptoms of heart failure.
Nearly all cases of pericardial disease in dogs are due to either idiopathic pericarditis (inflammation of the pericardium) or the presence of a tumour on the heart. Pericardiectomy is indicated for recurrent pericardial effusions, 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.
Pericardiectomy has a good 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 low (around 5%).
Some important requirements for successful pericardiectomy
- For best results, the procedure should be performed by a vet experienced in this surgery.
- A thorough ultrasound examination of the heart by an experienced cardiologist (ideally before and after drainage of fluid from the pericardial sac). Radiographs of the lungs and ultrasound examination of the abdomen are sometimes also useful to check for other evidence of malignancy.
- In our opinion, intravenous fluids prior to surgery and for at least 24 hours post-operatively, reduces the risk thromboembolism.
