A pericardial window is a cardiac surgical procedure to create a fistula – or "window" – from the pericardial space to the pleural cavity. The purpose of the window is to allow a

pericardial effusion A pericardial effusion is an abnormal accumulation of fluid in the pericardial cavity. The pericardium is a two-part membrane surrounding the heart: the outer fibrous connective membrane and an inner two-layered serous membrane. The two layers of t ...

or cardiac tamponade to drain from the space surrounding the

heart The heart is a muscular organ in most animals. This organ pumps blood through the blood vessels of the circulatory system. The pumped blood carries oxygen and nutrients to the body, while carrying metabolic waste such as carbon dioxide t ...

into the

chest cavity The thoracic cavity (or chest cavity) is the chamber of the body of vertebrates that is protected by the thoracic wall (rib cage and associated skin, muscle, and fascia). The central compartment of the thoracic cavity is the mediastinum. There ...

Uses

Pericardial window may be used to treat

and cardiac tamponade. It is the most common procedure to treat pericardial effusion, particularly if caused by

cancer Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body. These contrast with benign tumors, which do not spread. Possible signs and symptoms include a lump, abnormal b ...

. Untreated, these can lead to

death Death is the irreversible cessation of all biological functions that sustain an organism. For organisms with a brain, death can also be defined as the irreversible cessation of functioning of the whole brain, including brainstem, and brain ...

. The pericardial window decreases the incidence of postoperative pericardial tamponade and new-onset atrial fibrillation after

open-heart surgery Cardiac surgery, or cardiovascular surgery, is surgery on the heart or great vessels performed by cardiac surgeons. It is often used to treat complications of ischemic heart disease (for example, with coronary artery bypass grafting); to corr ...

Risks

Creation of a pericardial window is a major

surgical procedure Surgery ''cheirourgikē'' (composed of χείρ, "hand", and ἔργον, "work"), via la, chirurgiae, meaning "hand work". is a medical specialty that uses operative manual and instrumental techniques on a person to investigate or treat a pat ...

. To remove pericardial fluid, other more minor techniques should be considered first, such as pericardiocentesis.

Technique

Pericardial window is usually performed under general anaesthetic by a cardiac surgeon. They may make an open

surgical incision In surgery, a surgical incision is a cut made through the skin and soft tissue to facilitate an Surgery, operation or medical procedure, procedure. Often, multiple incisions are possible for an operation. In general, a surgical incision is made as ...

of up to 10 cm. This is usually located below the xiphoid process of the sternum (sub-xiphoid). Alternatively, access may be gained thoracoscopically with a smaller surgical incision. A small hole of between 1 cm and 2 cm is cut in the

pericardium The pericardium, also called pericardial sac, is a double-walled sac containing the heart and the roots of the great vessels. It has two layers, an outer layer made of strong connective tissue (fibrous pericardium), and an inner layer made of ...

, which is the membrane that surrounds the

. This allows for any pericardial fluid and other fluid to escape from the pericardium.

History

Pericardial window was first performed by

Baron Baron is a rank of nobility or title of honour, often hereditary, in various European countries, either current or historical. The female equivalent is baroness. Typically, the title denotes an aristocrat who ranks higher than a lord or knig ...

Dominique Jean Larrey in

1829 Events January–March * January 19 – August Klingemann's adaptation of Johann Wolfgang von Goethe's ''Faust'' premieres in Braunschweig. * February 27 – Battle of Tarqui: Troops of Gran Colombia and Peru battle to a draw. * March ...

Other animals

Pericardial windows are commonly used in

veterinary medicine Veterinary medicine is the branch of medicine that deals with the prevention, management, diagnosis, and treatment of disease, disorder, and injury in animals. Along with this, it deals with animal rearing, husbandry, breeding, research on nutri ...

to treat pericardial effusion. Whereas a sub-xiphoid skin incision is preferred in humans, a left para-xiphoid skin incision is preferred in cats.

References

External links

Cardiac Surgery in the Adult: Pericardial disease
Cardiac surgery {{Treatment-stub