What is an ECHO (Echocardiogram) with pericardial window?

From the Guidelines

An ECHO with pericardial window is a diagnostic ultrasound procedure that examines the heart and pericardium to detect fluid collections, thickening, or other abnormalities in the pericardial space, and is commonly ordered when pericardial effusion is suspected due to symptoms like chest pain or shortness of breath. This procedure uses sound waves to create detailed images of the heart's structure and function, and the pericardial window aspect refers to the targeted imaging of the pericardial space to detect effusions, thickening, or other abnormalities 1. The test is non-invasive, painless, and requires no special preparation beyond possibly removing jewelry and wearing a hospital gown.

Key Points to Consider

• The procedure typically takes 30-60 minutes to complete and is performed by a technician who applies gel to the chest and uses a transducer to obtain images from different angles.
• The pericardial window aspect of the procedure is crucial in detecting fluid collections, thickening, or other abnormalities in the pericardial space, which can be indicative of pericardial effusion or other conditions 1.
• The test is commonly ordered when pericardial effusion is suspected due to symptoms like chest pain, shortness of breath, or after certain medical conditions such as heart attacks, infections, or cancer treatments.
• While an ECHO with pericardial window can diagnose the presence of pericardial fluid, a separate surgical procedure (also called a pericardial window) may be needed to drain significant effusions if they're compromising heart function, as noted in the 2015 ESC guidelines for the diagnosis and management of pericardial diseases 1.

Clinical Considerations

• The size of pericardial effusion on two-dimensional echocardiography is qualitatively assessed by the end-diastolic distance of the echo-free space between the epicardium and parietal pericardium, with small, moderate, and large effusions defined as <10 mm, 10-20 mm, and >20 mm, respectively 1.
• Loculated pericardial effusions or pericardial effusions that contain clots may be difficult to diagnose using a transthoracic approach and may require transoesophageal echocardiography.
• Electrocardiogram is useful in the diagnosis of acute pericarditis, but echocardiography is the imaging modality of choice in the diagnosis of pericardial effusion and cardiac tamponade, as noted in a study on cardiovascular complications of cancer therapy 1.

From the Research

ECHO with Pericardial Window

• An ECHO (Echocardiogram) with pericardial window refers to the use of echocardiography to guide the creation of a pericardial window, which is a surgical procedure that involves removing a portion of the pericardium to allow for drainage of fluid that has accumulated in the pericardial space 2.
• The pericardial window is typically created to treat pericardial effusions, which are accumulations of fluid in the pericardial space that can compress the heart and impede its function 2.
• Echocardiography is used to guide the creation of the pericardial window by providing real-time images of the heart and pericardial space, allowing the surgeon to accurately locate the fluid accumulation and create the window in the correct location 2.

Indications for ECHO with Pericardial Window

• The creation of a pericardial window is typically indicated in patients with large pericardial effusions that are causing cardiac tamponade, which is a life-threatening condition that occurs when the fluid accumulation in the pericardial space compresses the heart and impedes its function 3, 2.
• Echocardiography is essential in the diagnosis and management of pericardial effusions and cardiac tamponade, as it allows for the accurate assessment of the size and location of the fluid accumulation, as well as the hemodynamic effects of the effusion on the heart 3, 4, 5, 6.

Echocardiographic Findings

• The echocardiographic findings that suggest a pericardial effusion is causing tamponade include:
  • Diastolic right ventricular collapse (high specificity) 4, 6
  • Systolic right atrial collapse (earliest sign) 4, 6
  • A plethoric inferior vena cava with minimal respiratory variation (high sensitivity) 4, 6
  • Exaggerated respiratory cycle changes in mitral and tricuspid valve in-flow velocities as a surrogate for pulsus paradoxus 4, 6
• These findings, in combination with clinical symptoms and physical examination, can help diagnose pericardial tamponade and guide management decisions, including the creation of a pericardial window 3, 2, 4, 5, 6.