Introduction
The heart sits inside a thin sac called the pericardium. If too much fluid collects in this sac (pericardial effusion), it can press on the heart and make it hard for it to fill — a dangerous condition called cardiac tamponade.
In a pericardial window operation, the surgeon makes a small opening in the sac so that fluid can drain into the chest or abdomen and be absorbed, instead of building up around the heart.
Why the procedure is needed
Fluid around the heart may cause:
- Breathlessness, especially when lying flat
- Chest discomfort, a feeling of pressure or fullness in the chest
- Low blood pressure, dizziness or fainting if tamponade develops
- Swollen neck veins and rapid heart rate
- Recurrent fluid build-up after drainage with a needle
Who may benefit
- People with a pericardial effusion that keeps returning after drainage with a needle or catheter
- People whose fluid needs to be tested, or in whom a biopsy of the pericardium is needed to find the cause
- People with effusion due to causes such as infection, cancer, kidney failure, previous heart surgery or inflammation
- Patients in whom the heart team judges surgery to be safer or more effective than repeated needle drainage
Ways to make the window
- Subxiphoid approach
- A small cut below the breastbone gives access to the pericardium without opening the chest.
- Thoracoscopic (keyhole) approach
- Small cuts between the ribs and a camera allow the window to be made from the side of the chest.
- Fluid and biopsy
- The fluid is drained and sent for tests, and a piece of the pericardium may be taken for examination.
- Drain
- A drain may be left in for a day or two to let the remaining fluid out.
- Treating the cause
- The window treats the fluid, not its cause. The underlying condition also needs treatment.
Procedure overview
Step 1: Assessment
Echocardiography shows how much fluid is present and whether it is pressing on the heart. Blood tests and other tests look for the cause.
Step 2: Anaesthesia
Usually general anaesthesia, although local anaesthesia with sedation is sometimes used for a small approach.
Step 3: Access
A small incision is made below the breastbone, or small cuts between the ribs are used for the keyhole method.
Step 4: Creating the window
The fluid is drained, and a small piece of the pericardium is removed to create a lasting opening. A biopsy may be taken.
Step 5: Drain and closure
A drain may be placed and the cuts closed with small stitches.
Step 6: Recovery
Recovery is usually quicker than after open-heart surgery. A check echo confirms that the fluid has not returned.
Clinical advantages
- Relieves pressure on the heart and the symptoms caused by the fluid
- Lowers the chance of fluid returning compared with needle drainage alone
- Allows the fluid and pericardium to be tested to find the cause
- Smaller incisions and a shorter recovery than major heart surgery
Risks and considerations
Every operation carries risk. The points below are general; your own risk depends on your health and on the operation you need.
- Bleeding, infection or reaction to anaesthesia
- Injury to the heart, lung or nearby organs (uncommon)
- Fluid may collect again, and further treatment may be needed
- The cause of the effusion may still need treatment, for example for infection or cancer
- Risk depends on how sick the patient is, especially when the fluid has already caused tamponade
Frequently asked questions
Why not just drain the fluid with a needle?
Needle drainage can work, but the fluid often returns. A window gives the fluid a lasting way out.
Is this open-heart surgery?
No. It is a smaller operation done through a small incision or keyhole cuts, without opening the heart.
Will the cause be found?
The fluid and a piece of pericardium may be tested, and these tests often help, but sometimes the cause is not found.
How long is the hospital stay?
Often a few days, but it depends on the cause and your general condition.
When should I seek urgent help?
If you develop worsening breathlessness, chest pain, fainting or a racing heartbeat, seek medical attention immediately.
Patient-friendly summary
A pericardial window is a small operation that lets fluid around the heart drain away, relieving pressure on the heart and reducing the chance that the fluid returns. It also allows tests to find the cause. The underlying condition still needs treatment, and a cardiologist or cardiothoracic surgeon should decide on the best approach.