Pericardial Window

Everyone is born with a pericardium, which is the fluid filled sac around the heart that acts as a “buffer”. Pericardial effusion (or "fluid around the heart") is an abnormal accumulation of fluid in the pericardial cavity. Because of the limited amount of space in the pericardial cavity, fluid accumulation leads to an increased pressure which can negatively affect heart function. A pericardial effusion with enough pressure to adversely affect heart function is called cardiac tamponade.

The causes of a pericardial effusion are many but may include:

• Viral infection (coxsackie virus)
• Bacterial Infection
• Inflammatory disorders, such as lupus and post myocardial infarction pericarditis (Dressler's syndrome or inflammation of pericardium)
• Cancer that has spread to the pericardium
• Kidney failure with excessive blood levels of urea nitrogen
• Minoxidil
• Hypothyroidism

Treatment depends on the underlying cause and the severity of the heart impairment. Pericardial effusion due to a viral infection usually goes away within a few weeks without treatment. Some pericardial effusions remain small and never need treatment. If the pericardial effusion is due to inflammation, treatment with anti-inflammatory medications may help (ie: Motrin, celebrex or colchicine). If the effusion is compromising heart function and causing cardiac tamponade, it will need to be drained, most commonly by a needle inserted through the chest wall and into the pericardial space called pericardiocentesis. A drainage tube is often left in place for several days. In some cases, surgical drainage may be required by cutting through the pericardium creating a “pericardial window”. Your surgeon may make the small incision either on one of your sides under your armpit or right below your sternum (called a “sub-xyphoid” approach) in the bottom/middle of your chest. Our surgeons can use minimally invasive techniques such as videoassisted thoracoscopic surgery (VATS) to perform the procedure if you are a candidate.

After Pericardial Window

Patients having Pericardial Window typically stay in the hospital 5-7 days. There is one tube draining fluid around the heart. When the tube is removed, the patient can expect to go home. They usually have a PCA for pain which is transitioned to oral pain medications when the tube is removed. Patients start with a clear liquid diet and are advanced to a regular diet if they tolerate clear liquids. Patients are encouraged to be out of bed and walk as much as possible.