Surgical treatment of recurrent idiopathic pericarditis

Abstract

Pericardiectomy has long been recognized as the procedure of choice in the definitive treatment of chronic constrictive pericarditis. Recently it has been advocated and used successfully in the management of recurrent idiopathic pericarditis. The latter can be a very crippling disease eventually leading to chronic invalidism. The usual case of idiopathic pericarditis is self limited and responds well to symptomatic medical management. Rarely, however, relapses will occur characterized by severe chest pain, fever and weakness. A pericardial friction rub can be heard and a pericardial effusion is usually seen on the chest roentgenogram, proved by pericardiocentesis. Examination of the fluid, and pericardial tissue as well, has persistently failed to reveal the etiologic agent although a virus seems most likely. When exacerbations of the disease occur with increasing frequency, the patient becomes a virtual invalid. At this point, which admittedly is often difficult to ascertain, a pericardiectomy can reverse the trend and restore the patient to health. Since there is little adherence of the pericardium to the epicardium, the operation is relatively safe and easy, and affords tissue for diagnosis to rule out tuberculosis definitely. We prefer this to steroid therapy which seems only to temporize and further complicate the situation.