Pericardial Window

The pericardium is a thin, fluid-filled sac that envelopes the heart. Pericardial effusion is a disease characterised by an excess accumulation of fluid in the sac, leading to impairment in the heart’s functions. Pericardial window, also called subxyphoid pericardiostomy, involves the opening of a small portion of the pericardium to drain out the accumulated fluid.

Indication

Pericardial window is a minimally invasive, diagnostic as well as therapeutic procedure indicated for the following:

• Pericardial effusion showing symptoms of chest pain, discomfort or pressure, light-headedness, cough, hoarseness, palpitations, dyspnoea (shortness of breath) and anxiety
• Haemodynamically stable (blood pressure is adequate to supply blood to all parts of the body) with undiagnosed pericardial effusion
• Purulent pericardial effusion (infection of pericardial space)
• Pericarditis (inflammation of the pericardium)
• Benign effusions that recur even after aspiration
• Chylopericardium (accumulation of milky fluid containing lymph and fat in the pericardium)
• Delayed haemopericardium (blood in the pericardial sac) or effusions after cardiac surgery

Pericardial window may be contraindicated for concomitant cardiac surgery which requires sternotomy (an incision made to separate the chest bone).

Procedure

Pericardial window is usually performed under general anaesthesia. There are different approaches to the procedure. These include:

Subxiphoid Approach: A vertical incision is made from the tip of the breast bone (xiphoid) extending along the midline of the abdomen. The xiphoid is completely removed and the pericardium is held by a hook. The pericardium is incised and a sucker is inserted to remove extra fluid. The incisions are sutured in layers.

Thoracotomy Approach: The intercostal space (space between ribs) is exposed by making a small incision on the skin along the crease at the bottom of the breast. Your doctor places a retractor to separate the tissues and expose the pericardium. The pericardium is cut and the sample of the pleural fluid is collected for examination. The incision is made on the pericardium in front of the phrenic nerve (nerve that starts in the neck and passes down the lung and heart). The adjacent lung is examined and a chest tube is inserted within the pericardium. The fluid is removed using suction and the incision is closed in layers.

Thoracoscopic Approach: In this method, a thoracoscope, an instrument used to visualise the chest cavity, is used. An incision is made in the 7th intercostal space and the pericardium is exposed and incised. A sucker is inserted to drain the fluid accumulated and the incisions are sutured firmly.

Complications

As with other diagnostic and treatment procedures, pericardial window may be associated with certain complications, including:

• Infection
• Bleeding
• Cardiac arrest
• Myocardial infarction (heart attack)
• Arrhythmia (irregular heart beat)
• Reoccurrence of pericardial effusion, requiring reoperation