Posted on October 31st, 2010 under Heart Valve Replacement, Surgeons & Clinics.
I just received a very interesting question from Bernie about the pericardium and heart valve surgery.
Bernie writes, “Hi Adam – At 51 years old, I need to replace my disease aortic valve due to a stenotic bicuspid valve. I’m curious to know about the pericardium. I know the sac has to be opened. But, then what? Do they stitch-up the pericardium after the valve is fixed? Or, is it left open? Thanks, Bernie.”
Interestingly… I had this exact same question prior to my heart valve surgery. However, before we answer Bernie’s question, I want to make sure we all know what the pericardium is.
The pericardium is the fluid-filled sac that surrounds the heart and the ends of the aorta, vena cava, and the pulmonary artery. The double-layered pericardium has several functions:
- The pericardium keeps the heart contained in the chest cavity.
- The pericardium also prevents the heart from over-expanding when blood volume increases.
- The pericardium limits heart motion.
Now that we know a little more about the pericardium, let’s consider what happens during heart valve surgery. Once the patient is on the heart-lung machine and the heart is stopped, the surgeon will approach the heart using a minimally invasive technique (mini-thoracotomy, mini-sternotomy) or median sternotomy. Then, the pericardium is opened. This enables the surgeon to access the diseased heart valve.
After the valve is fixed or replaced, the surgeon has two options relative to the pericardium. The surgeon can stitch-up the pericardium. Or, the surgeon can leave the pericardium open. Dr. Eric Roselli, MD, heart surgeon at the Cleveland Clinic, explained it to me in the following way:
“Some surgeons close the pericardium. Most do not. At The Cleveland Clinic, we do not close the pericardium. Our clinical work and research does not indicate a distinct benefit in closing the pericardium… And, there is a potential, increased risk for cardiac tamponade if the pericardium is closed.” — Dr. Eric Roselli
If you didn’t know, cardiac tamponade is a compression of the heart that can occur when blood or fluid builds up in the space between the myocardium (the heart muscle) and the pericardium. Dr. Roselli describes cardiac tamponade as a “suffocating of the heart with blood or other fluid that collects around it”.
Some other interesting facts about the pericardium:
- The pericardium is composed of very strong, very thick connective tissue. It appears this is why bovine and equine valves utilize the pericardial tissue of cows and horses when manufacturing leaflets for valve replacement devices.
- The patient’s own pericardium can be used for other purposes during surgery. According to Cincinnati Children’s Hopsital, a surgeon can remove a small portion of the pericardium to patch holes in the heart.
I hope this helped Bernie (and perhaps you) learn a little more about the pericardium and heart surgery. Thanks to Bernie for his question. And, a special thanks to Dr. Roselli for his ongoing support of this community.
Keep on tickin!