Pericardial Window
The pericardium is the sac that encloses the heart. A pericardial effusion is an abnormal accumulation of fluid in the pericardial cavity. Because it is a small space with normally only up to 50ml of fluid present, a large effusion causes increased pressure in that space, compromising heart function. When severe and causing right heart chamber collapse, it is known as cardiac tamponade and is a surgical emergency. Symptoms may include shortness of breath, chest pain and low blood pressure.
There are many potential causes, including but not limited to pericarditis, infection (viral or bacterial), inflammatory disorders such as lupus or rheumatoid arthritis, kidney failure and cancer.
It may be diagnosed on CT scan or by echocardiography.
If the effusion is large and is causing, or has the potential to cause, tamponade, a subxiphoid pericardial window is performed. This involves a small incision at the bottom of the sternum and upper abdomen through which the pericardium is opened and drained, and a small drainage tube is left in place. The drain typically remains in place for two days and is then removed. The fluid and a small piece of pericardium are then analyzed to determine the cause of the effusion. Treatment is directed accordingly.