Pericardial window - Misplaced Pages

Cardiac surgical procedure Medical intervention

Pericardial window
ICD-9-CM	37.12
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A pericardial window is a cardiac surgical procedure to create a fistula – or "window" – from the pericardial space to the pleural cavity. 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.

Uses

Pericardial window may be used to treat pericardial effusion and cardiac tamponade. It is the most common procedure to treat pericardial effusion, particularly if caused by cancer. 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.

Risks

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

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. This is usually located below the xiphoid process of the sternum (sub-xiphoid). Alternatively, access may be gained thoracoscopically with a smaller surgical incision. A small hole of between 1 cm and 2 cm is cut in the pericardium, which is the membrane that surrounds the heart. This allows for any pericardial fluid and other fluid to escape from the pericardium.

History

Pericardial window was first performed by Baron Dominique Jean Larrey in 1829.

Other animals

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

References

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.
^ 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
^ 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
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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.
^ 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, JIan A.; Trunkey, Donald D. (eds.), "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
^ 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
Larrey, D. J. (1829). "New surgical procedure to open the pericardium in case of fluid in its cavity". Clinical Chir. 2: 303–307.
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