What is a pericardial window?

A pericardial window is a procedure done on the sac around the heart. Surgically removing a small part of the sac lets healthcare providers drain extra fluid from the sac and into the pleural cavity.

A fibrous sac called the pericardium surrounds the heart. This sac has 2 thin layers with a small amount of fluid in between them. The fluid helps reduce friction between the 2 layers as they rub against each other when the heart beats. In some cases, too much fluid builds up between the layers. This is called a pericardial effusion. When this happens, the heart has trouble functioning correctly. A pericardial window is one method of draining excess fluid and preventing future fluid buildup.

Healthcare providers can do a pericardial window in a number of ways. In most cases, it's done under general anesthesia. In one approach, the surgeon makes a cut under the bottom of the breastbone to get to the pericardium. Or the surgeon makes a cut between the ribs to reach the pericardium. healthcare providers may also perform a method that uses several small incisions on the side of the chest. This is called video-assisted thoracoscopy, or VATS. They use small cameras and small tools to create the pericardial window through these small holes.

Why might I need a pericardial window?

Many different conditions can cause fluid to build up abnormally around the heart. This can cause shortness of breath, dizziness, nausea, low blood pressure, and chest pain. Sometimes this is treatable with medicines. In other cases, this abnormal fluid is life-threatening and requires urgent drainage.

A pericardial window can help decrease the fluid around the heart. It can also help diagnose the cause of the extra fluid. Conditions that might need a pericardial window include:

• Infection of the heart or pericardial sac

• Cancer

• Inflammation of the pericardial sac due to a heart attack

• Injury

• Immune system disease

• Reactions to certain medicines

• Radiation

• Metabolic causes, like kidney failure with uremia

Sometimes healthcare providers don’t know why the fluid builds up.

A pericardial window is not the only way to remove fluid around the heart. Another procedure used by healthcare providers is pericardiocentesis. This uses a needle and a long, thin tube (a catheter) to drain the fluid from the heart. But if your condition makes this method difficult, or if the fluid has returned after being drained, your provider is more likely to use a pericardial window. Your provider might also be more likely to advise surgery if you have had catheter pericardiocentesis in the past and the excess fluid came back. You are also more likely to need surgery if a piece of your pericardium needs to be examined. This is done to diagnose the source of the fluid.

The fluid from the heart can also be drained without a piece of the pericardium being removed. Ask your provider about which procedure makes the most sense for you.

What are the risks of a pericardial window?

All procedures have some risks. The risks of pericardial window include:

• Excess bleeding

• Infection

• Blood clot (which can lead to stroke or other problems)

• Abnormal heart rhythms (which can cause death in rare instances)

• Heart attack

• Complications from anesthesia

• Return of extra fluid

• Need for a repeat procedure

• Damage to the heart

There is also a chance that the fluid around the heart will come back. If this happens, you might need to repeat the procedure. Or you might eventually need the whole pericardium removed.

Your own risks may vary according to your age, your general health, and the reason for your procedure or type of surgery you have. They may also vary depending on the anatomy of the heart, fluid, and pericardium. Talk with your healthcare provider to find out what risks may apply to you.

How do I get ready for a pericardial window?

Ask your healthcare provider how to prepare for a pericardial window procedure. You will be given directions to not eat or drink anything for a certain amount of time before surgery. Ask the provider whether you need to stop taking any medicines before the surgery.

The provider may want some extra tests before the surgery. These might include:

• Chest X-ray

• Electrocardiogram (ECG), to check the heart rhythm

• Blood tests, to assess general health

• Echocardiogram to view heart anatomy and blood flow through the heart

• Imaging tests, such as CT or MRI, if the provider needs more information about the heart

• Heart catheterization to measure the pressures within the heart

Any hair around the area of the operation may be removed.

What happens during a pericardial window?

Talk with the healthcare provider about what to expect during the surgery. The details of your surgery will vary according to the kind of repair done. Usually, providers do the repair without the use of cardiopulmonary bypass (a heart-lung machine). The team will carefully monitor your vital signs during the repair. In general:

• An anesthesiologist will probably give you general anesthesia before the surgery starts. You will sleep deeply and painlessly during the operation. You may have a breathing tube put down your throat during surgery to help you breathe. You won’t remember it afterwards.

• In a few cases, healthcare providers might not do the procedure under general anesthesia. If this is the case, the they will give you a medicine to make you relax during the procedure. They will also provide numbing medicines at the sites of the incisions.

• The surgery will take several hours.

• There are several options for the procedure:

• In some cases, the surgeon will make a cut (incision) a few inches below the breastbone. Or between the ribs. Tools are used through this incision. If thoracoscopy is used, several smaller incisions on the side of the chest are made instead. Small cameras and tools are inserted through these small incisions.

• The provider will remove a small portion of the pericardium, creating a “window.”

• The provider might place a chest tube or another surgically placed drain between the layers of the pericardium. Or in the cavity of the lungs to help drain the fluid.

• A sample of the fluid may be sent to a lab for analysis.

• The muscle and the skin incisions will be closed and a bandage applied.

What happens after a pericardial window?

Ask your healthcare provider about what to expect after the procedure. In general, after your pericardial window:

• You may be groggy and disoriented upon waking.

• Your vital signs, such as your heart rate, breathing, blood pressure, and oxygen levels, will be closely watched.

• You will probably have a tube draining the fluid from your heart or chest that may remain in place for a few days

• You may feel some soreness, but you shouldn’t feel severe pain. Pain medicines are available if needed.

• You will probably be able to drink the day after surgery. You can have regular foods as soon as you can tolerate them.

• You will probably need to stay in the hospital for at least a few days. This will partially depend on the reason you needed a pericardial window.

After you leave the hospital:

• You will have your stitches or staples removed in a follow-up appointment in 7 to 10 days. Be sure to keep all follow-up appointments.

• You should be able to resume normal activities relatively soon, but you may be a little more tired for a while after the surgery.

• Ask the provider if you have any exercise limitations. Stay away from heavy lifting.

• Call the provider if you have fever, increased draining from the wound, increased chest pain, or any severe symptoms.

• Follow all the instructions your healthcare provider gives you for medicines, exercise, diet, and wound care.

Many people note improvements in their symptoms right after having a pericardial window done.

Next steps

Before you agree to the test or procedure make sure you know:

• The name of the test or procedure

• The reason you are having the test or procedure

• What results to expect and what they mean

• The risks and benefits of the test or procedure

• What the possible side effects or complications are

• When and where you are to have the test or procedure

• Who will do the test or procedure and what that person’s qualifications are

• What would happen if you did not have the test or procedure

• Any alternative tests or procedures to think about

• When and how you will get the results

• Who to call after the test or procedure if you have questions or problems

• How much you will have to pay for the test or procedure