Cardiothoracic Surgery

Pericardial Window

Illustration of heart beat waves on a window

What Is a Pericardial Window?

A pericardial window, also known as a pericardiostomy, is a surgical procedure in which a doctor cuts out a small part of the pericardium to drain unwanted fluid.

What Is the Pericardium?

The heart is enclosed in a sac of strong, fibrous tissue, which is known as the pericardium. It acts much like a protective wrapper for the heart, supporting it and helping to protect it against injury and infection. It is filled with pericardial fluid, which helps to lubricate the heart.

Sometimes, however, the pericardium can become infected or damaged by injury to the chest. Diseases such as cancer, lupus, heart disease, and hypothyroidism can also affect the pericardium. This can cause it to fill with excess blood or pericardial fluid, which is referred to as pericardial effusion.

Effusion may not be noticeable at first. But if the pericardium becomes too full, it will begin to compress the heart instead of supporting it, a condition called tamponade. This is usually experienced as a squeezing or painful sensation in the chest, often accompanied by shortness of breath. Left untreated, tamponade can damage the heart, slow its beating, or even cause it to stop.

Treatment of Pericardial Effusion

When a doctor suspects something may be wrong with the pericardium, he or she will usually request tests such as an echocardiogram or chest X-ray to locate irregularities in the heartbeat and find the location of the effusion.

If the effusion is not serious, drugs can treat it and/or by aspiration -- that is, using a needle or small tube to draw off the excess fluid. A pericardial window is performed only in more serious cases, where the infusion cannot be treated by those simpler methods. Examples of more serious cases include inflammation of the pericardium, infections after heart surgery, effusions that keep recurring despite treatment, and cases where the symptoms of tamponade are present.

How Is a Pericardial Window Procedure Performed?

A pericardial window is a minimally invasive operation that is performed under general anesthesia. The surgeon will usually make a small incision below the breastbone. This is referred to as a subxiphoid pericardial window procedure. It takes its name from the xiphoid process, the hardened cartilage structure at the bottom of the breastbone.

Depending on the location of the effusion, it may be easier for the surgeon to go in between the ribs rather than from beneath the breastbone. This is usually referred to as a thoracotomy.

The surgeon will cut a small hole in the pericardium and drain the excess fluid. The hole is left open afterward so any further fluid will drain into the abdomen to be reabsorbed by the body. If the effusion is serious and there is a great deal of excess fluid, the surgeon may also insert a small tube to allow the pericardium to drain externally.

Pericardial Window Recovery and Risks

Any form of surgery, especially on such a vital organ as the heart, has a certain level of risk associated with it, including risks of infection, blood clots, damage to the heart, or heart attacks. However, a pericardial window is a relatively simple and minimally invasive procedure and is much less dangerous than open-heart surgery.

A pericardial window usually requires a few days' hospital stay after the surgery. You should not drink for a day after the surgery, but you can eat as soon as you feel ready to do so. Once discharged from the hospital, you will probably need to come back in a week to have stitches removed. You can return to your normal activities, but your doctor will explain any restrictions on exercise and exertion -- you should certainly avoid lifting anything heavy while your incision is healing.

If you experience fever, nausea, excessive pains, or swelling around the incision after the surgery, contact the doctor immediately. These can be signs of pericardial window complications such as infection.