Tuesday, February 7, 2023
HomeClinical ProceduresPericardial Window

Pericardial Window

Overview

Background

Pericardial window is used diagnostically and, more often, therapeutically for drainage of accumulated pericardial fluid (a condition that most often occurs after cardiac surgery but has many other possible causes). The pericardium envelops the heart like a cocoon; its cardiac filling can be impaired when this cavity fills with excess fluid. When the limited space between the noncompliant pericardium and heart is acutely filled with blood or fluid, cardiac compression and tamponade may result. Pericardial window in combination with systemic chemotherapy may also prevent accumulation of large fluid volumes in patients with neoplastic pericardial disease.

Pericardial window involves the excision of a portion of the pericardium, which allows the effusion to drain continuously into the peritoneum or chest.
The fluid can be drained in any of 3 ways: via a small subxiphoid incision, thoracoscopically,
or via a thoracotomy.

Indications

The following are indications for a pericardial window
:

Symptomatic pericardial effusions

Asymptomatic pericardial effusions that warrant a pericardial window for diagnosis

Hemodynamically stable patients with an undiagnosed pericardial effusion (a thoracoscopic approach is ideal)

Coexisting pericardial, pleural, or pulmonary pathology that requires diagnosis or therapy (a thoracoscopic approach is ideal)

Known benign effusions that reaccumulate after aspiration

Drainage of a purulent pericardial effusion

Early fungal or tuberculous pericarditis in which resection of the pericardium is required to prevent future pericardial constriction

Use as part of the mediastinal debridement, in patients with descending mediastinitis

Loculated effusions situated unilaterally or posteriorly (more easily approached thoracoscopically)

Chylopericardium (thoracoscopic window and ligation of the thoracic duct)

Delayed hemopericardium or effusions after cardiac surgery (usually treated via a subxiphoid approach, but a thoracoscopic approach is also used)

An effusion in a patient with a substernal gastric or colonic conduit in whom a subxiphoid approach is not possible (an unusual indication for a thoracoscopic pericardial window)

Contraindications

The following is a contraindication for a pericardial window
:

Concomitant cardiac surgery necessitating a sternotomy for which a full pericardiotomy would be performed

Technical Considerations

The following technical points may improve the performance of pericardial window procedures:

If the patient is unstable, employ the subxiphoid approach

Use the Allis clamp to grasp the pericardium

Resect an adequate area of pericardium

Ensure that no undrained areas of the pericardial space remain by using a sucker to explore all areas

Previous articleWDHA Syndrome
Next articleArteriovenous Malformations
RELATED ARTICLES
- Advertisment -

Most Popular