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What is a Pericardial Window

A pericardial window drains excess fluids to prevent pericardial effusion complications.

The pericardium is the protective sac surrounding the heart. The sac holds a small amount of fluid meant to protect the heart. If the pericardium overfills, it may lead to heart conditions such as pericardial effusion or pericarditis.

Pericardial effusion is the most common medical term used to describe abnormal pericardium fluid accumulation. This is generally the result of equilibrium distress causing structural abnormality in the pericardial cavity. The pericardial cavity has a limited amount of space. An accumulation of fluid causes increased pressure in the pericardium which can interfere with heart function. Extreme pericardial pressure can lead to cardiac tamponade

Types of pericardial window procedures

There are three primary pericardial window procedures. These include:

Subxiphoid – A dermal (skin) incision from the top of the breast to the middle of the abdomen. The breastbone is removed and the pericardium is secured with small hanger-like devices. A small incision is cut in the pericardium and a tube is inserted to drain the excess fluid. The pericardial incision is stitched back closed and the breastbone put back in place. Afterward, the dermal incision is stitched closed.

Thoracotomy – A small dermal incision is made between the ribs just below the breast plate. A tool called a retractor is used to separate the ribs and expose the pericardium. A small incision is made in the pericardium to remove a fluid sample for examination. Then, a second pericardium incision is made to expose the nerve that passes between the neck, heart, and lungs. A tube is inserted into the pericardium to remove excess fluids. Then, the incisions are closed.

Thoracoscopic – A scope is inserted through a small incision within the pericardium. If there are access fluids, it will be drained using a small tube. Then, the incisions are closed. 

Preparing for pericardial window

Doctors often advise their patient not to eat or drink for 24 hours before surgery. Some medications may hinder the way the anesthetics work. Make sure your doctor knows the following

  • List of all medications including dietary supplements and vitamins.
  • If you smoke it can increase the risks of certain surgical complications.
  • A complete medical history including prior surgeries or medical conditions.
  • List all known allergies.
  • Tell your doctor if you are pregnant.

Your healthcare provider may order additional tests in preparation for a pericardial window procedure.

What to expect during a pericardial window procedure

An anesthesiologist administers anesthesia prior to surgery. The anesthesia is meant to prevent pain by putting patients to sleep during the procedure. Some medications could cause a reaction to general anesthetics. In these cases, medications may be used to prevent pain during the procedure.

After the anesthetic takes effect, a breathing tube is inserted into the throat to keep breathing stabilized. Patients can expect the procedure to last several hours. Your vital signs will be watched during the procedure. In some cases, a cardiopulmonary bypass may be used to stabilize the heart during the procedure.

The details and methods of each procedure may vary depending on each patient’s various needs.

Pericardial window recovery expectations

Each patient may experience a variation in recovery time.

General recovery expectations

  • Disorientation and grogginess upon awakening
  • Tenderness at the surgical site
  • A hospital stay lasting a couple of days during recovery
  • A chest tube may remain in place during recovery
  • Close monitoring of the vital signs
  • Most patients can resume their normal diet the day of surgery


A follow-up appointment will be necessary 7 – 10 days after surgery. Some patients experience mild energy loss for a while. However, most people can resume normal activity soon after surgery. Ask your surgeon if there are any exercise lifting restrictions.

What causes pericardial fluid buildup

Conditions that may require a pericardial window include

  • Heart attack or infection
  • Pericardial infection
  • Cancer
  • Chest injury
  • Immune system disease
  • Kidney disease
  • Drug reaction
  • Radiation

Signs a pericardial window may be necessary

A pericardial window may be needed if you experience

  • Sudden sharp chest pain
  • Sharp pain in the back, shoulders, neck or stomach
  • Swelling of the legs, ankles or feet
  • Anxiety or fatigue
  • Trouble breathing or dry hacking cough

Risks of pericardial window

The risks of pericardial window include:

  • Excess bleeding
  • Heart or pericardial infection
  • Blood clotting
  • Arrhythmia (irregular heart beat)
  • Cardiac arrest
  • Anesthetic reaction

Pericardial window prognosis

Pericarditis symptoms may persist for a few months. In rare instances, excess fluid may return after a pericardial window which requires additional surgery.

A pericardial window can be a useful procedure when it comes to preventing heart complications. Always make sure you are aware of the benefits and risks before undergoing any medical procedure. 

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