Subtotal Pericardiectomy in Dogs

When fluid builds up in the pericardial space around your dog's heart, referred to as pericardial effusion, this fluid needs to be removed. This can be a life-threatening condition, as excess fluid places pressure on the cardiac muscles and interferes with functioning. Pericardiocentesis is usually the first line of treatment to extract fluid by performing a “tap” of the pericardial space to extract liquid, however, if this fails to resolve the condition a partial or subtotal pericardiectomy may need to be performed. A partial or subtotal pericardiectomy is a surgical procedure performed by a thoracoscopy, to remove pericardium tissue and allow fluid to drain into the thoracic cavity. This surgery requires supportive care and expertise and is performed by a veterinarian with your dog under general anesthesia. In addition, removal of neoplasia present in the pericardium may be performed with removal of a portion of pericardial tissue by subtotal pericardiectomy.

If pericardial taps fail to resolve fluid build up in the pericardial cavity your dog will be prepared for subtotal pericardiectomy. This will require a thoracotomy, an incision into the thoracic cavity. Your dog will be required to fast prior to administration of anesthesia. Your dog will be sedated, administered supportive care with intravenous fluids, and anesthesia and an intubation tube to maintain anesthetic by gas inserted. Monitoring of vital signs and maintenance of appropriate air pressure in lungs is required and an experienced anesthesiologist is beneficial for this procedure. The dog is placed in dorsal recumbency and the chest area shaved and cleaned antiseptically prior to opening of the chest cavity. The incision may be intercostal, by median sternotomy, or several small incisions may be made to allow for an thoracostomy using a camera, cautery and thoracoscopic instruments. Ventilation is required to maintain a positive pressure to the lungs. Instruments are used to access the pericardium and make a cut with a cautery unit into the pericardium. Fluid will be released from this cut and suction to allow visualization may be required. More cuts are made to remove a small portion of ventral pericardium and retract it through one of the thoracostomy ports. Your veterinary surgeon will be careful to avoid lungs, vessels and nerves The use of a cautery tool usually controls bleeding from the procedure. If thoracostomy encounters complications, then an open approach may be required to access the pericardium. If neoplasia is present the tissue extracted along with lesion or tumor will be submitted for pathology assessment. Catheters are placed in the ports to allow for fluid to drain. Thoracostomy ports are closed and catheters removed. Your dog will be placed into recover from anesthetic and supportive care administered.

This procedure aids in recovering tissue to be assessed for the presence of malignancy or to provide relief from pericardial effusion. It may be an effective tool to provide comfort in palliative patients. 

Prognosis for pericardial effusion depends on the underlying cause. If neoplasia is present, long-term prognosis may be poor, but in cases of idiopathic effusion or where underlying causes can be addressed, relief of the condition and recovery can be achieved.

Dogs will be hospitalized and provided supportive care and monitoring after the procedure. Pain management will be provided and should be administered as directed. Your dog should rest for several days after thoracic surgery and their vital signs be carefully monitored. Observe your dog for signs of hemorrhaging or infection and obtain veterinary assistance immediately if required. Prevent your dog from interfering with the incision with the use of an e-collar and bandaging of feet if scratching is an issue. Sutures will need to be removed and follow up with your veterinarian should be scheduled in 10 to 14 days, or as recommended by your veterinarian. Monitor food and fluid intake and elimination, and address any concerns with your veterinarian. 

Specialized training and instruments are required to perform subtotal pericardiectomy by thoracotomy and the cost ranges from $2,000 to $5,000. If an open approach is used, the cost may be less, but recovery and complications are more common, which may also incur expenses. 

Complications such as hypoventilation, shock , hypothermia, hemorrhage, postoperative pain and complications from anesthetic are serious risks associated with thoracic surgery. The underlying cause of pleural effusion may not be addressed and if cancerous lesions are present, the cost can be prohibitive and prognosis is poor.

Prevention of neoplasia or idiopathic pericardial effusion may be unlikely. Preventing accidents from occurring to your dog which may result in cardiac trauma and pericardial effusion may reduce instances in some cases. Early intervention when your dog manifests signs of cardiac compromise is vital to achieving a successful outcome.