Is Pericardial Window Surgery Dangerous?

Pericardial window surgery cuts a hole in the heart's protective sack to allow fluid from a pericardial effusion to drain, relieving pressure on the heart.

The heart is surrounded by a two-layered sac (pericardium) with a small amount of fluid. When excess fluid accumulates in the pericardium (pericardial effusion) it exerts pressure and impairs the heart’s function.

A pericardial window is a procedure to remove a portion of the pericardium and create a ‘window’ to continuously drain the excess fluid into the chest cavity. A pericardial window can, therefore, prevent impairment of heart function that can occur with a pericardial effusion.

Pericardial window is a cardiac surgical procedure less invasive than an open-heart surgery. It is often done after an open-heart surgery to drain and prevent pericardial effusion. Pericardial window may be performed when pericardiocentesis, a less invasive method of fluid removal, is not possible, or if pericardial effusion persists or recurs after pericardiocentesis.

Pericardial window is a procedure to prevent impairment of heart function as a result of a pericardial effusion. The procedure is performed to

• Relieve symptoms of pericardial effusion such as
  • shortness of breath
  • rapid breath
  • dizziness
  • nausea
  • chest pain
• To treat cardiac tamponade (severe impairment of heart’s function due to pressure caused by pericardial effusion)
• Diagnose the cause of pericardial effusion
• Drain recurrent pericardial effusion
• Prevent pericardial effusion after an open-heart surgery

Pericardial window may be required due to the following conditions:

• Chest injury
• Heart attack and heart failure
• Reaction to certain drugs
• Lung and certain other cancers
• Radiation treatment to the chest
• Inflammation of the pericardium (pericarditis) 
• High level of urea in the blood (uremia) due to kidney disease/failure
• Still disease
• Hypothyroidism
• Connective tissue diseases
• Genetic muscle degeneration disease
• Human immunodeficiency virus (HIV) infection

A cardiac surgeon performs the pericardial window procedure  while the patient is under general anesthesia. The procedure may take several hours.

Preparation

• The patient undergoes blood and imaging tests.
• The patient must avoid eating or drinking for 8 hours prior.
• The patient must check with the doctor before taking any regular medication
• The patient must inform the surgeon about any allergies.

Procedure

• An anesthesiologist will administer anesthesia and monitor the patient’s vital functions during the procedure.
• An IV line will be attached for medications.
• External defibrillator pads will be attached, in case the patient develops irregular heartbeat (arrhythmia).
• The arterial and venous blood pressure will be continuously monitored during the procedure.
• The surgeon may perform the pericardial window using one of the following three techniques:
  • Subxiphoid approach: The surgeon makes a 5- to 8-cm long incision in the midline just below the breastbone to visualize and access the pericardium from below.
  • Thoracotomy approach: The surgeon makes a 6- to 8-cm long incision in the fourth or fifth intercostal space (space between the ribs) to visualize and access the pericardium.
  • Thoracoscopic approach: The surgeon makes small incisions on the side of the chest and performs the procedure with tiny surgical tools inserted through a flexible tube with a lighted camera (thoracoscope), guided by the images on a monitor.
• The surgeon surgically removes a portion of the pericardium creating a ‘window’.
• The surgeon drains the excess fluid and attaches a small tube enabling the fluid to continue draining into the chest cavity.
• The incisions will be closed with sutures or staples.
• The patient will be monitored for several hours in the recovery room.
• The fluid and tissue removed is analyzed in the lab.
• Hospital stay for about a week to 10 days is required, and recovery can take up to eight weeks, depending on the underlying condition and any complications.

Pericardial window surgery is a relatively safe procedure and could be potentially lifesaving. The success of the procedure, however, depends in part on the underlying condition of the patient.

The recurrence of pericardial effusion after a pericardial window procedure is possible. Recurrence depends on its original cause.

Pericardial window is a major procedure on a vital organ. Risks and complications include:

• Complications from anesthesia
• Uncontrolled bleeding
• Blood clots leading to stroke
• Infection
• Recurrence of pericardial effusion
• Arrhythmia
• Heart attack
• Cardiac arrest
• Death