Pericardial window

A pericardial window is a cardiac surgical procedure to create a fistula – or "window" – from the pericardial space to the pleural cavity.[1] The purpose of the window is to allow a pericardial effusion or cardiac tamponade to drain from the space surrounding the heart into the chest cavity.[2]

Pericardial window
ICD-9-CM37.12

Uses

Pericardial window may be used to treat pericardial effusion and cardiac tamponade.[2][3] It is the most common procedure to treat pericardial effusion, particularly if caused by cancer.[4] Untreated, these can lead to death. The pericardial window decreases the incidence of postoperative pericardial tamponade and new-onset atrial fibrillation after open-heart surgery.[5]

Risks

Creation of a pericardial window is a major surgical procedure.[6] To remove pericardial fluid, other more minor techniques should be considered first, such as pericardiocentesis.[4]

Technique

Pericardial window is usually performed under general anaesthetic by a cardiac surgeon. They may make an open surgical incision of up to 10 cm.[6] This is usually located below the xiphoid process of the sternum (sub-xiphoid).[4] Alternatively, access may be gained thoracoscopically with a smaller surgical incision.[3][7] A small hole of between 1 cm and 2 cm is cut in the pericardium, which is the membrane that surrounds the heart.[6] This allows for any pericardial fluid and other fluid to escape from the pericardium.[6]

History

Pericardial window was first performed by Baron Dominique Jean Larrey in 1829.[6][8]

Other animals

Pericardial windows are commonly used in veterinary medicine to treat pericardial effusion.[7] Whereas a sub-xiphoid skin incision is preferred in humans, a left para-xiphoid skin incision is preferred in cats.[9]

References
  1. Stuart J. Hutchison (2008). Pericardial diseases: clinical diagnostic imaging atlas. Elsevier Health Sciences. pp. 93–. ISBN 978-1-4160-5274-6. Retrieved 10 November 2010.
  2. Ghavidel, Alireza Alizadeh; Hosseini, Saeid (2018-01-01), Maleki, Majid; Alizadehasl, Azin; Haghjoo, Majid (eds.), "Chapter 37 - Principles of Cardiovascular Surgery", Practical Cardiology, Elsevier, pp. 647–659, doi:10.1016/b978-0-323-51149-0.00037-7, ISBN 978-0-323-51149-0, retrieved 2020-12-02
  3. Laste, Nancy J (2009-01-01), Silverstein, Deborah C.; Hopper, Kate (eds.), "Chapter 44 - Pericardial Diseases", Small Animal Critical Care Medicine, Saint Louis: W.B. Saunders, pp. 184–188, doi:10.1016/b978-1-4160-2591-7.10044-x, ISBN 978-1-4160-2591-7, retrieved 2020-12-02
  4. Fashoyin-Aje, Lola A.; Brahmer, Julie R. (2020-01-01), Niederhuber, John E.; Armitage, James O.; Kastan, Michael B.; Doroshow, James H. (eds.), "59 - Malignancy-Related Effusions", Abeloff's Clinical Oncology (Sixth Edition), Philadelphia: Elsevier, pp. 863–873.e4, doi:10.1016/b978-0-323-47674-4.00059-1, ISBN 978-0-323-47674-4, retrieved 2020-12-02
  5. Zhao J (Apr 2014). "Does posterior pericardial window technique prevent pericardial tamponade after cardiac surgery?". J Int Med Res. 42 (2): 416–26. doi:10.1177/0300060513515436. PMID 24553479.
  6. Asensio, Juan A.; García-Núñez, Luis Manuel; Petrone, Patrizio; Duran, Dominic; Vara, Alexander D.; Weston, John S.; Gmora, Scott B.; Feinstein, Ara; Robinson, Donald (2008-01-01), Asensio, JUAN A.; Trunkey, DONALD D. (eds.), "CHAPTER 40 - CARDIAC INJURIES", Current Therapy of Trauma and Surgical Critical Care, Philadelphia: Mosby, pp. 304–315, doi:10.1016/b978-0-323-04418-9.50044-8, ISBN 978-0-323-04418-9, retrieved 2020-12-02
  7. Clarke, Dana L.; Culp, William T. N. (2015-01-01), Silverstein, Deborah C.; Hopper, Kate (eds.), "Chapter 136 - Minimally Invasive Procedures", Small Animal Critical Care Medicine (Second Edition), St. Louis: W.B. Saunders, pp. 715–721, doi:10.1016/b978-1-4557-0306-7.00136-7, ISBN 978-1-4557-0306-7, retrieved 2020-12-02
  8. Larrey, D. J. (1829). "New surgical procedure to open the pericardium in case of fluid in its cavity". Clinical Chir. 2: 303–307.
  9. van Nimwegen, S. A.; Kirpensteijn, J. (2014-01-01), Langley-Hobbs, Sorrel J.; Demetriou, Jackie L.; Ladlow, Jane F. (eds.), "Chapter 42 - Thoracoscopy", Feline Soft Tissue and General Surgery, W.B. Saunders, pp. 487–493, doi:10.1016/b978-0-7020-4336-9.00042-1, ISBN 978-0-7020-4336-9, retrieved 2020-12-02


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