Is a pericardial window indicated for recurrent cardiac tamponade?

From the Guidelines

A pericardial window is indicated for recurrent cardiac tamponade, as it provides a palliative solution by creating a communication from the pericardial space to the pleural cavity, allowing for the drainage of pericardial effusions and preventing recurrent tamponade. This procedure is typically considered for patients with recurrent large effusions or cardiac tamponade, especially when more complex operations like pericardiectomy are high-risk or the patient has a reduced life expectancy due to conditions such as neoplastic pericardial disease 1. The creation of a pericardial window can be performed by a cardiac surgeon or through less invasive methods like video-assisted thoracoscopy or balloon pericardiotomy.

Key points to consider in the decision-making process include:

• The patient's overall health status and life expectancy
• The underlying cause of the recurrent tamponade
• The risks and benefits associated with the procedure
• The potential need for additional interventions due to the possibility of the communication closing or recurrent effusions 1.

In clinical practice, the decision to proceed with a pericardial window for recurrent cardiac tamponade should be made on a case-by-case basis, taking into account the individual patient's circumstances and the potential impact on their quality of life and morbidity. The primary goal of the procedure is to improve the patient's quality of life by reducing the frequency and severity of recurrent tamponade episodes, thereby minimizing the need for repeated hospitalizations and invasive procedures 1.

From the Research

Indications for Pericardial Window

A pericardial window is indicated for recurrent cardiac tamponade, as it allows for the drainage of pericardial effusion into the abdominal or thoracic cavities. The following points highlight the indications and benefits of a pericardial window:

• Recurrent pericardial effusion secondary to systemic lupus erythematosus can be managed with a pericardial window, as seen in a case report where a 58-year-old female underwent creation of pericardioperitoneal and pericardiopleural windows via a single-incision subxiphoid approach 2.
• Percutaneous balloon pericardiotomy is a non-surgical treatment option for patients with cardiac tamponade, where a pericardial window is created using a balloon dilating catheter 3.
• Subxiphoid pericardiotomy and pericardial drainage can be performed for the management of continuous pericardial effusion, especially in patients with neoplastic cardiac tamponade 4.

Treatment Options for Pericardial Effusion

The treatment of pericardial effusion depends on various clinical factors and the patient's history. The following options are available:

• Pericardiocentesis is preferred in acute pericardial effusion with cardiac tamponade to avoid general anesthesia 5.
• Pleuro-pericardial window on VATS is better in chronic pericardial effusion, especially in cases of infective or systemic disease, and in recurrence after subxiphoid drainage 5.
• Subxiphoid drainage is suitable for all neoplastic patients and in cases of unknown etiology, allowing for pericardioscopy to be performed 5.

Potential Complications

While a pericardial window can be an effective treatment option, it is not without potential complications. For example:

• Paradoxical hemodynamic collapse can occur after subxiphoid pericardial window, as seen in a case report where a patient developed acutely decompensated right heart failure after drainage of pericardial fluid 6.