From the Guidelines
A pericardial window procedure is a recommended approach for managing pericardial effusion, particularly in cases of recurrent large effusions or cardiac tamponade, as it allows for drainage of the effusion into the pleural cavity and can be performed via various methods, including video-assisted thoracoscopy or balloon pericardiotomy. This procedure is typically indicated for patients with neoplastic pericardial disease or those with reduced life expectancy, where a more complex operation like pericardiectomy may be high-risk 1. The goal of the pericardial window is to prevent large pericardial effusions and cardiac tamponade by creating a communication between the pericardial space and the pleural cavity.
Some key points to consider when performing a pericardial window procedure include:
- The procedure can be performed by a cardiac surgeon or via percutaneous intervention
- The main indication is recurrent large effusions or cardiac tamponade, particularly in patients with reduced life expectancy or high-risk for more complex operations
- The results of a pericardial window may be less definitive compared to pericardiectomy, as the communication may close and recurrent effusions can occur 1
- The procedure can be effective in managing pericardial effusion and preventing cardiac tamponade, but may require additional interventions in some cases.
In terms of the approach, the pericardial window can be created via various methods, including:
- Video-assisted thoracoscopy
- Balloon pericardiotomy
- Subxiphoid pericardial window. It is essential to weigh the benefits and risks of each approach and consider the individual patient's needs and circumstances when deciding on the best course of treatment 1.
From the Research
Window Procedure for Pericardial Effusion
A window procedure for pericardial effusion is a surgical intervention aimed at creating a pathway for the drainage of excess fluid accumulated in the pericardial space. The following are key points regarding this procedure:
- Pericardial window creation is considered for patients with recurrent cardiac tamponade or symptomatic pericardial effusion, either circumferential or loculated 2.
- The procedure can be performed through video-assisted thoracoscopic surgery (VATS) or a small subxiphoid incision 3.
- Pericardial window creation through VATS has been shown to reduce the frequency of pericardial effusion recurrence compared to pericardial drainage through a small subxiphoid incision 3.
- Consultation of cardiac surgery for pericardial window creation should be considered in recurrent cases and may be the first-line approach to malignant effusions 4.
- A pleuro-pericardial window on VATS is better in chronic pericardial effusion (for infective or systemic disease) and in recurrence, after performing subxiphoid drainage 5.
Indications for Window Procedure
The indications for a window procedure in pericardial effusion include:
- Recurrent cardiac tamponade
- Symptomatic pericardial effusion (either circumferential or loculated)
- Malignant effusions
- Chronic pericardial effusion (for infective or systemic disease)
- Recurrence after subxiphoid drainage
Comparison with Other Treatments
The window procedure is compared to other treatments as follows:
- Pericardiocentesis is preferred in acute pericardial effusion with cardiac tamponade to avoid general anesthesia 5.
- Subxiphoid drainage is suitable for all neoplastic patients and in cases of unknown etiology to perform pericardioscopy 5.
- Pericardial window creation through VATS has been shown to be more effective in reducing recurrence compared to pericardial drainage through a small subxiphoid incision 3.