Pericardial Window

The heart is surrounded by a double-layered sac called the pericardium. Between these two layers, there is a space known as the pericardial cavity. The pericardial cavity normally contains a small amount of pericardial fluid. This fluid prevents friction between the two layers and helps your heart move easier within the sac. If too much fluid accumulates between the pericardium and the heart itself, the condition is known as pericardial effusion. Because of the limited amount of space in the pericardial cavity, fluid accumulation leads to an increased pressure which can negatively affect heart function. To alleviate such, a pericardial window or pericardiocentesis may be performed.

A pericardial window is a minimally invasive procedure (small incisions of 2–3 inches long, done under general anesthesia) performed to remove a small part of the pericardium. Afterwards, doctors will be able to drain the excess fluid from the sac extracted.

Do you have a question? Request more information and we will connect you with an RWJBarnabas Health cardiovascular expert.

Do You Need a Pericardial Window Procedure?

To determine whether you need this procedure, your doctor might perform a variety of diagnostic tests, including:

• Chest X-Rays
• Electrocardiogram (EKG/ECG)
• Blood tests
• Echocardiogram (ECHO)
• Computed tomography (CT scan)
• Magnetic resonance imaging (MRI)
• Cardiac catheterization

How to Prepare for Pericardial Window Surgery

Prior to the procedure, your doctor and treatment team will explain to you what to expect before, during and after the procedure and potential risks of the procedure. Talk to your doctor about:

• All medications, herbal products and dietary supplements you are currently taking and ask for their recommendations about each.
• Radiation exposure, especially for those that are pregnant.
• Any allergies to medicines, latex, tape, iodine, and anesthetic agents.
• Any history of bleeding disorders.
• Any body piercings on your chest or abdomen.

Other recommendations include:

• Eat a normal meal the evening before the procedure. However, do not eat, drink or chew anything after midnight before your procedure. If you must take medications, only take them with sips of water.
• Leave all jewelry at home.
• Remove all makeup and nail polish.
• Wear comfortable clothing when you come to the hospital.
• If you normally wear dentures, glasses, or hearing devices at home, plan to wear them during the procedure.

What to Expect During Pericardial Window Surgery

A pericardial window will typically take between 1 to 2 hours to complete. This procedure is typically performed in the operating room. Check with your doctor about the details of your procedure. In general:

• You will change into a hospital gown.
• A nurse will start the intravenous (IV) line in your arm which will administer medications and fluids during the procedure.
• Usually, your doctor will administer general anesthesia (make you feel sleepy). In a few cases, doctors might not do the procedure under general anesthesia. If this is the case, the doctor will give you a medication to make you relax during the procedure.
• Once you are sedated, your doctor may insert a breathing tube through your throat into your lungs and connect you to a ventilator. This will breathe for you during surgery.
• Your doctor will make a cut (incision) a few inches below the breastbone, or between the ribs. Tools are pushed through this incision.
• Your doctor will then proceed to surgically remove a small portion of the pericardium, creating a “window.”
• Afterwards, a chest tube will be placed 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 to Expect After the Procedure

After the surgery, you will be taken to the stepdown unit or the cardiothoracic intensive care unit (CTICU) depending on your condition. You will be in the hospital for 5-7 days. Other recommendations include:

General Guidelines

• Your vital signs, such as your heart rate, breathing, blood pressure, and oxygen levels, will be closely monitored.
• You will probably have a tube draining the fluid from your heart or chest.
• You may feel some soreness, but you shouldn’t feel severe pain. Pain medications 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.
• Ambulation is started on the first or second day of surgery.
• You can probably do your normal activities after the surgery. But, you may need to take it easy at first. No heavy lifting or vigorous exercises until your body has healed.
• Your doctor will give you instructions to follow during your recovery.

Do you have a question? Request more information and we will connect you with an RWJBarnabas Health cardiovascular expert.