Pericardial window

A pericardial window is a cardiac surgical procedure to create a fistula – or "window" – from the pericardial space to the pleural cavity.^[1] The purpose of the window is to allow a pericardial effusion or cardiac tamponade to drain from the space surrounding the heart into the chest cavity.^[2]

Pericardial window
ICD-9-CM	37.12

Uses

Pericardial window may be used to treat pericardial effusion and cardiac tamponade.^[2][3] It is the most common procedure to treat pericardial effusion, particularly if caused by cancer.^[4] Untreated, these can lead to death. The pericardial window decreases the incidence of postoperative pericardial tamponade and new-onset atrial fibrillation after open-heart surgery.^[5]

Risks

Creation of a pericardial window is a major surgical procedure.^[6] To remove pericardial fluid, other more minor techniques should be considered first, such as pericardiocentesis.^[4]

Technique

Pericardial window is usually performed under general anaesthetic by a cardiac surgeon. They may make an open surgical incision of up to 10 cm.^[6] This is usually located below the xiphoid process of the sternum (sub-xiphoid).^[4] Alternatively, access may be gained thoracoscopically with a smaller surgical incision.^[3][7] A small hole of between 1 cm and 2 cm is cut in the pericardium, which is the membrane that surrounds the heart.^[6] This allows for any pericardial fluid and other fluid to escape from the pericardium.^[6]

History

Pericardial window was first performed by Baron Dominique Jean Larrey in 1829.^[6][8]

Other animals

Pericardial windows are commonly used in veterinary medicine to treat pericardial effusion.^[7] Whereas a sub-xiphoid skin incision is preferred in humans, a left para-xiphoid skin incision is preferred in cats.^[9]