Surgical management of pyogenic pericarditis.

Sixteen cases of acute pyogenic pericarditis have been reviewed. Uncontrollable septic course, episodes of cardiac tamponade and failure of the nonsurgical regimen were the main indications for surgery. Medical management is often ineffective because of the relentless septic course, presence of thick, viscid pus and granulation tissue, and loculation. Even if it is effective, it may not halt the progression to constriction. We treated these cases by emergency pericardiectomy. The results were gratifying, the risk of cardiac tamponade was eliminated and termination of the septic course was dramatic. The mortality rate was within acceptable limits. All the survivors have remained asymptomatic.