Pericardial Window

A pericardial window is a procedure done on the sac around the heart. Surgically removing a small part of the sac lets doctors drain excess fluid from the sac. A fibrous sac called the pericardium surrounds the heart.

This sac has two thin layers with a small amount of fluid in between them. The fluid helps reduce friction between the two layers as they rub against each other when the heartbeats. In some cases, too much fluid builds up between the layers. When this happens, the heart has trouble functioning properly. A pericardial window is one method of draining excess fluid and preventing future fluid buildup.

Doctors can do a pericardial window in several ways. In most cases, doctors do the procedure under general anesthesia. In one approach, the surgeon cuts the bottom of the breastbone to get to the pericardium. Alternatively, the surgeon cuts the ribs to reach the pericardium. Doctors may also perform a method that uses several small incisions on the side of the chest. This is called video-assisted thoracoscopy, or VATS. They use small cameras and small tools to create the pericardial window through these tiny holes.

Why might I need a pericardial window?

Many different conditions can cause fluid to build up abnormally around the heart. This can cause shortness of breath, dizziness, nausea, low blood pressure, and chest pain. Sometimes this is treatable with medications. In other cases, this abnormal fluid is life-threatening and requires urgent drainage.

A pericardial window can help decrease the fluid around the heart. It can also help diagnose the source of the extra fluid. Conditions that might need a pericardial window include:

  • Infection of the heart or pericardial sac
  • Cancer
  • Inflammation of the pericardial sac due to a heart attack
  • Injury
  • Immune system disease
  • Reactions to certain drugs
  • Radiation
  • Metabolic causes, like kidney failure with uremia

Sometimes doctors don’t know why the fluid builds up.

A pericardial window is not the only way to remove fluid around the heart. Another procedure used by doctors is catheter pericardiocentesis. This uses a needle and a long, thin tube (a catheter) to drain the fluid from the heart. However, if your condition makes this method difficult, your doctor is more likely to use a pericardial window. Your doctor might also be more likely to advise surgery if you have had catheter pericardiocentesis in the past and the excess fluid came back. You are also more likely to need surgery if a piece of your pericardium needs to be examined. This is done to diagnose the source of the fluid.

The fluid from the heart can also be drained without a piece of the pericardium being removed. Ask your doctor about which procedure makes the most sense for you.

What are the risks of a pericardial window?

All procedures have some risks. The risks of pericardial window include:

  • Excess bleeding
  • Infection
  • Blood clot (which can lead to stroke or other problems)
  • Abnormal heart rhythms (which can cause death in rare instances)
  • Heart attack
  • Complications from anesthesia
  • Return of extra fluid
  • Need for a repeat procedure
  • Damage to the heart

There is also a chance that the fluid around the heart will come back. If this happens, you might need to repeat the procedure, or you might eventually need the whole pericardium removed.

Your risks may vary according to your age, your general health, and the reason for your procedure or type of surgery you have. They may also vary depending on the anatomy of the heart, fluid, and pericardium. Talk with your healthcare provider to find out what risks may apply to you.

How do I get ready for a pericardial window?

Ask your doctor how to prepare for a pericardial window procedure. It would be best if you did not eat or drink anything after midnight before the day of the surgery. Ask the doctor whether you need to stop taking any medications before the surgery.

The doctor may want some extra tests before the surgery. These might include:

  • Chest X-ray
  • Electrocardiogram (ECG), to check the heart rhythm
  • Blood tests, to assess general health
  • Echocardiogram, to view heart anatomy and blood flow through the heart
  • CT or MRI, if the doctor needs more information about the heart
  • Heart catheterization, to measure the pressures within the heart

Any hair around the area of the operation may be removed. About an hour before the operation, you may be given medicines to help you relax.

What happens during a pericardial window?

Talk with the doctor about what to expect during the surgery. The details of your surgery will vary according to the kind of repair the doctor is doing. Usually, doctors repair without the use of cardiopulmonary bypass (a heart-lung machine).

During the repair, the team will carefully monitor your vital signs. In general:

  • An anesthesiologist will probably give you general anesthesia before the surgery starts. You will sleep deeply and painlessly during the operation. You may have a breathing tube put down your throat during surgery to help you breathe. You won’t remember it afterward.
  • In a few cases, doctors might not do the procedure under general anesthesia. If this is the case, the doctor will give you a medication to make you relax during the procedure. The doctor will also provide numbing medications at the sites of the incisions.
  • The surgery will take several hours.
  • There are several options for the procedure:
  • In some cases, the surgeon will cut (incision) a few inches below the breastbone, or between the ribs. Tools are used through this incision. If thoracoscopy is used, several smaller incisions on the side of the chest instead. Small cameras and tools are inserted through these small incisions.
  • The doctor will surgically remove a small portion of the pericardium, creating a “window.”
  • The doctor might place a chest tube between the layers of the pericardium or in the cavity of the lungs, to help drain the fluid.
  • A sample of the fluid may be sent to a lab for analysis.
  • The muscle and the skin incisions will be closed, and a bandage applied.

What happens after a pericardial window?

Ask your doctor about what to expect after the procedure. In general, after your pericardial window:

  • You may be groggy and disoriented upon waking.
  • Your vital signs, such as your heart rate, breathing, blood pressure, and oxygen levels, will be closely monitored.
  • You will probably have a tube draining the fluid from your heart or chest.
  • You may feel some soreness, but you shouldn’t feel severe pain. Pain medications are available if needed.
  • You will probably be able to drink the day after surgery. You can have regular foods as soon as you can tolerate them.
  • You will probably need to stay in the hospital for at least a few days. This will partially depend on the reason you needed a pericardial window.
    After you leave the hospital:
  • You will have your stitches or staples removed in a follow-up appointment in 7 to 10 days. Be sure to keep all follow-up appointments.
  • You should be able to resume normal activities relatively soon, but you may be a little more tired for a while after the surgery.
  • Ask the doctor if you have any exercise limitations. Avoid heavy lifting.
  • Call the doctor if you have a fever, increased draining from the wound, increased chest pain, or any severe symptoms.
  • Follow all the instructions your healthcare provider gives you for medications, exercise, diet, and wound care.
    Many people note improvements in their symptoms right after having a pericardial window done.
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