Minimally invasive procedure rescues drowning hearts

Often mistaken as a heart attack, it's one of the most misdiagnosed heart problems there is. One in 1000 people will develop it at some point in their life and many times it strikes a person in their 30's or 40's. The problem causes the heart to literally drown or suffocate to death.

"The waves were pretty big," said Linda Gould-Faber, Pericarditis Patient.

During a sailing trip, an oar struck Linda Gould-Faber smack dab in the middle of her chest.

"It hit me right here, full force," said Gould-Faber

Linda hurt her pericardium

"It is the skin around the heart that protects the heart from infection," said Allan Klein, MD, cardiologist at the Cleveland Clinic.

When damaged, fluid can build up between the layers of the pericardium and the heart.

"It's one of the worst cardiac pains that you can imagine," said Dr. Klein.

Caused by trauma in Linda's case, viral infections, arthritis, and lupus can also put you at risk. Most people with pericarditis think they are having a heart attack.

"All of the sudden, they can't take a breath. It hurts to breath. They break out in a sweat," said Dr. Klein.

An echocardiogram showed Linda's sac was full of fluid.

Instead of open heart surgery, cardiologists performed a minimally invasive partial pericardiectomy.

"Right in the operating room, the pressures come down dramatically," said Dr. Klein.

More than 30 ounces of fluid was drained from Linda's pericardium. The surgery cut her recovery time to three weeks compared to two months for open heart surgery.

"One of the things that is amazing, I have no restrictions. I can do all sorts of physical activity," said Gould-Faber.

To prove it, Linda climbed a volcano in Hawaii.

The first treatment option for viral pericarditis is anti-inflammatories and occasionally steroids. Once drugs are no longer effective, patients would have to undergo open heart surgery to fix the problem. Without surgery, pericarditis can lead to heart failure.

BACKGROUND: The pericardium, also called heart sac (theca cordis), is a fibroserous sac that surrounds the heart and the roots of the great vessels. It consists of the serous pericardium and the fibrous pericardium. The serous pericardium consists of the parietal layer, which lines the inside of the fibrous pericardium, and the visceral layer, which adheres to the surface of the heart. Between the two layers is the pericardial space, which contains a few drops of pericardial fluid to lubricate opposing surfaces of the space and allow the heart to move easily during contraction. The fibrous pericardium, which constitutes the outermost sac and is composed of tough, white fibrous tissue lined by the parietal layer of the serous pericardium, fits loosely around the heart and attaches to large blood vessels emerging from the top of the heart but not to the heart itself. It is relatively inelastic and protects the heart and the serous membranes. (Source: Medical-dictionary.thefreedictionary.com)

Pericarditis is a swelling and irritation of the pericardium and often causes chest pain and sometimes other symptoms. Pericarditis is usually sudden and short-lived (acute). It is usually caused by trauma, viral infection, bacterial infection, rheumatoid arthritis, and lupus.

SIGNS: Injury or disease may cause fluid to accumulate in the space, causing a wide separation between the heart and the outer pericardium. If pericardial fluid or pus accumulates in the pericardial space, the fibrous pericardium cannot stretch, causing a rapid increase of pressure around the heart. The symptoms may be similar to a heart attack and include chest pain and abnormal heart rhythms. (Source: Mayo Clinic)

TREATMENT: Your treatment choice for pericarditis depends on the cause as well as the severity. Mild cases of pericarditis may get better on their own without treatment. Medications to reduce the inflammation and swelling associated with pericarditis are often prescribed, including: over-the-counter pain relievers, narcotic pain relievers, colchicine (colcrys), corticosteroids. You'll likely need hospitalization if your doctor suspects cardiac tamponade, a dangerous complication of pericarditis due to fluid buildup around the heart. When cardiac tamponade is present, you may need a procedure called pericardiocentesis.
PARTIAL AND TOTAL PERICARDIECTOMY: In some cases of severe, recurrent pericarditis, your doctor might suggest surgically removing your pericardium (pericardiectomy). Pericardiocentesis is a procedure where a doctor uses a sterile needle or a small tube (catheter) to remove and drain the excess fluid from the pericardial cavity. You'll receive a local anesthetic before undergoing pericardiocentesis, which is often done with echocardiogram monitoring and ultrasound guidance. This drainage may continue for several days during the course of your hospitalization. If you're diagnosed with constrictive pericarditis, you may need to undergo a surgical procedure (pericardiectomy) to remove the entire pericardium that has become rigid and is making it hard for your heart to pump. (Source: Mayo Clinic). A partial pericadiectomy can reduce recovery time from two months to three weeks.

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FOR MORE INFORMATION, PLEASE CONTACT:

Andrea Pacetti
Cleveland Clinic
(216) 444-8168


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