Pericardial window
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Pericardial effusion.
Pericarditis is inflammation of the pericardium, the thin sac (membrane) that surrounds the heart. There is a small amount of fluid between the inner and outer layers of the pericardium. When the pericardium becomes inflamed, the amount of fluid between its two layers increases, compressing the heart and interfering with its ability to function properly.
Pericardial window is a 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, where the fluid is not as dangerous as around the heart.
How does the pericardial window procedure work?
The 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. 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.
Indication
The indication for surgery is a pericardial effusion (fluid build-up). an untreated pericardial effusion can lead to cardiac tamponade and death.
Results
Pericardial effusion has a variety of causes, including viral infection, cancer, renal disease, heart failure, hypothyroidism, and post cardiac surgery. A pericardial window is used both to provide a diagnosis (to know the cause of pericardial effusion) and to improve heart function. Depending on the underlying disease process, patients usually go home in two days.
References
Template:Cardiac surgery and other cardiovascular procedures Cateogry:Emergency medicine