This is usually accomplished by passing a tiny catheter into the pericardial sac, through a small incision made beneath the breastbone. If the effusion recurs, surgical drainage of the pericardial sac is sometimes required. Removing the fluid relieves the pressure on the heart, and restores normal cardiac function almost immediately. Chronic pericarditis is treated by identifying and treating the underlying cause, if possible. If recurrent pericardial effusions become a problem, surgery can be done to create a pericardial window, an opening that allows the fluid to drain from the pericardial sac, thus preventing tamponade.
Constrictive pericarditis is a very difficult therapeutic problem.
The treatment approach can be either symptomatic or definitive. Symptomatic treatment involves bed rest, diuretics, and digitalis. The definitive approach is surgical - the thickened pericardial lining is stripped from the outer wall of the heart, a procedure called pericardial resection. Because the constricted pericardium is adhered directly to the heart muscle, pericardial resection can be extremely difficult, tedious, and bloody, and the mortality rate can be quite high. For this reason, the obviously unsatisfactory symptomatic approach is often used for constrictive pericarditis.