Pericardial window

Revision as of 18:40, 18 September 2017 by WikiBot (talk | contribs) (Changes made per Mahshid's request)
Jump to navigation Jump to search

Pericarditis Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

HIV
Post MI
Dressler's syndrome
Post-pericardiotomy
Radiation
Tuberculosis
Uremia
Malignancy

Differentiating Pericarditis from other Diseases

Epidemiology and Demographics

Screening

Natural History, Complications and Prognosis

Pericardial Effusion
Cardiac Tamponade
Constrictive Pericarditis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-ray

Echocardiography and Ultrasound

CT scan

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Pericardiocentesis
Pericardial Window
Pericardial Stripping

Treatment Related Videos

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Pericardial window On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Google Images

American Roentgen Ray Society Images of Pericardial window

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Pericardial window

CDC on Pericardial window

Pericardial window in the news

Blogs on Pericardial window

Directions to Hospitals Treating Type page name here

Risk calculators and risk factors for Pericardial window

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor-in-Chief: Mohammed A. Sbeih, M.D. [2]

Overview

Creation of a pericardial window is a cardiac surgical procedure in which an opening is made in the pericardium to drain fluid that has accumulated around the heart by creating a fistula or "window" from the pericardial space to the peritoneal cavity. Flow of fluid into the peritoneal cavity prevents the accumulation of fluid around the heart (a pericardial effusion), which might cause compression and impaired filling of the heart (cardiac tamponade), a dangerous complication.[1] The procedure is performed for both diagnostic and therapeutic purposes. The creation of a pericardial window is usually performed by a cardiac surgeon or thoracic surgeon who makes an incision, commonly sub-xiphoid, and cuts a small hole in the pericardium. This surgery is performed with local anesthesia. An incision is made either below the sternum, or alternately between the ribs of the left chest. The resection can be with scissors, cautery, a stapling device, or a harmonic scalpel, with no one technique demonstrably better than another. It is best to have a combination of techniques available to resect the pericardium adequately. The surgeon may place a catheter in the pericardial window so that fluid can continue to drain for a short period of time after the surgery. Chest tubes are removed in 2-3 days once the drainage is less than 200cc/24hrs.

Indication

The indication for creation of a pericardial window is a pericardial effusion (fluid build-up) that is either symptomatic, or if the patient is on the verge of cardiac tamponade or if cardiac tamponade has developed. A surgical approach is recommended only in patients with very large chronic effusion, for whom repeated pericardiocentesis have been unsuccessful.

Procedure

Performing a pericardial window traditionally required open-chest surgery, resulting in a large scar and a lengthy recovery time. With the advent of minimally-invasive robotic surgery and the thoracoscopic approach to pericardial window, however, a new approach became available resulting in less trauma, less pain and faster recovery, even that until recently, patients in tamponade were considered unsuitable for a thoracoscopic window.

There are 2 approaches for pericardial window procedure:
1. Subxiphoid approach A short vertical incision (about 5-7 cm long) is made over the xiphoid process extending onto the midline of the abdomen. The linea alba is incised, and the xiphoid is often completely removed. By finger dissection, the surgeon can reach the retrosternal space. The diaphragmatic aspect of the pericardium is visualized by upward retraction. The pericardium can be grasped with the hook or can be incised directly. A sucker is inserted into the pericardial space and the fluid aspirated. Often a sucker or a finger is used for further dissection of any adhesions. After all the fluid has been aspirated, the epicardium is inspected and a biopsy specimen can also be taken from the pericardium. A finger is introduced into the pericardial space to determine if any additional adhesions exist or if any nodules are there in the pericardium. Finally, a tube is inserted into the pericardial space and connected through a separate stab wound; the incision is closed in layers.[2]
2. Thoracotomy approach A small anterior thoracotomy is made in the fourth or fifth intercostal space. To expose the chosen intercostal space, an inframammary skin incision (5-7 cm long) is made, which allows division of the pectoralis muscle. The intercostal space is opened over the superior margin of the rib entering the pleural cavity. A retractor is placed and the pericardium is visualized. The pericardium is incised anterior to the phrenic nerve with a scalpel or scissors. A window is created and the pericardial specimen is sent for histopathology, and samples of pleural effusion are obtained. A chest tube is placed within the pericardium and placed on water seal or suction and the incision is closed in layers.[2]

Recovery

Depending on the underlying disease process, patients can be usually discharged in two days.

References

  1. Stuart J. Hutchison (10 December 2008). Pericardial diseases: clinical diagnostic imaging atlas. Elsevier Health Sciences. pp. 93–. ISBN 9781416052746. Retrieved 10 November 2010.
  2. 2.0 2.1 Liberman M, Labos C, Sampalis JS, Sheiner NM, Mulder DS (2005). "Ten-year surgical experience with nontraumatic pericardial effusions: a comparison between the subxyphoid and transthoracic approaches to pericardial window". Arch Surg. 140 (2): 191–5. doi:10.1001/archsurg.140.2.191. PMID 15724002.

Template:Cardiac surgery and other cardiovascular procedures Cateogry:Emergency medicine

Template:WH Template:WS