Is Pericardial Window Surgery Dangerous?

What is a pericardial window procedure?

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.

Is pericardial window open-heart surgery?

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.

Why is a pericardial window procedure done?

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

How is a pericardial window procedure done?

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.

In the U.S., 1 in every 4 deaths is caused by heart disease.
See Answer

Is pericardial window surgery dangerous?

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.

Can pericardial effusion come back?

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

What are the risks and complications of pericardial window?

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