Pericardial window
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Associate Editors-in-Chief: Mohammed A. Sbeih, M.D. [2]
Overview
Creation of a pericardial window is a cardiac surgical procedure in which an opening is made in the pericardium to drain fluid that has accumulated around the heart by creating a fistula or "window" from the pericardial space to the peritoneal cavity. Flow of fluid into the peritoneal cavity prevents the accumulation of fluid around the heart (a pericardial effusion), which might cause compression and impaired filling of the heart (cardiac tamponade), a dangerous complication [1]. The procedure is performed for both diagnostic and therapeutic purposes.
Indication
The indication for creation of a pericardial window is a pericardial effusion (fluid build-up) that is either symptomatic, or if the patient is on the verge of cardiac tamponade or if cardiac tamponade has developed. A surgical approach is recommended only in patients with very large chronic effusion, for whom repeated pericardiocenteses have been unsuccessful.
The Procedure
Performing a pericardial window traditionally required open-chest surgery, resulting in a large scar and a lengthy recovery time. With the advent of minimally-invasive robotic surgery and the thoracoscopic approach to pericardial window, however, a new approach became available resulting in less trauma, less pain and faster recovery, even that Until recently, patients in tamponade were considered unsuitable for a thoracoscopic window.
The creation of a pericardial window is usually performed by a cardiac surgeon or thoracic surgeon who makes an incision, commonly sub-xiphoid, and cuts a small hole in the pericardium. This surgery is performed with local anesthesia. An incision is made either below the sternum, or alternately between the ribs of the left chest. The resection can be with scissors, cautery, a stapling device, or a harmonic scalpel, with no one technique demonstrably better than another. It is best to have a combination of techniques available to resect the pericardium adequately.
The surgeon may place a catheter in the pericardial window so that fluid can continue to drain for a short period of time after the surgery. Chest tubes are removed in 2-3 days once the drainage is less than 200cc/24hrs.
Recovery
Depending on the underlying disease process, patients usually go home in two days.
References
- ↑ Stuart J. Hutchison (10 December 2008). Pericardial diseases: clinical diagnostic imaging atlas. Elsevier Health Sciences. pp. 93–. ISBN 9781416052746. Retrieved 10 November 2010.
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