Pediatric pericardiectomy-a narrative review

Area of Science:

• Cardiology
• Pediatric Surgery
• Thoracic Surgery

Background:

• Pediatric pericardiectomies are uncommon surgical procedures.
• They are indicated for recurrent, purulent, or constrictive pericarditis in children.
• Current pediatric-specific guidelines are lacking.

Purpose of the Study:

• To review the existing literature on pediatric pericardiectomies.
• To summarize etiology, diagnosis, surgical timing, methods, and outcomes.
• To inform clinical decision-making in the absence of pediatric guidelines.

Main Methods:

• A systematic PubMed literature review was conducted.
• Articles published in English from 2000-2025 were included.
• Search terms included "pediatric" and "pericardiectomy"; 58 relevant publications were identified from 92 articles.

Main Results:

• Idiopathic pericarditis is the most common cause; bacterial infections and prior cardiac surgery are also significant etiologies.
• Most pediatric patients present with dyspnea, chest pain, or heart failure.
• Transthoracic echocardiogram (TTE) is the primary diagnostic imaging tool.
• Pericardiectomy is the standard treatment for constrictive pericarditis, with delayed surgery potentially causing irreversible myocardial damage.
• Approximately 90% of procedures are performed without cardiopulmonary bypass, often via median sternotomy.
• Mortality rates are higher in lower-resourced countries (~11%) compared to the US (~2%), potentially due to delayed presentation or disease etiology.

Conclusions:

• Pediatric pericardiectomies are rare but generally safe, particularly in the United States.
• Adult guidelines can inform treatment decisions for pediatric patients.
• Further research is needed to clarify outcomes related to the timing of pediatric pericardiectomies.