Stab heart closing the pericardium,leaving a small window

Pericardial window is used diagnostically and, more often, therapeutically for drainage of accumulated pericardial fluid (a condition that most often occurs after cardiac surgery but has many other possible causes). The pericardium envelops the heart like a cocoon; its cardiac filling can be impaired when this cavity fills with excess fluid. When the limited space between the noncompliant pericardium and heart is acutely filled with blood or fluid, cardiac compression and tamponade may result. Pericardial window in combination with systemic chemotherapy may also prevent accumulation of large fluid volumes in patients with neoplastic pericardial disease. [1, 2] Indications The following are indications for a pericardial window [6] : Symptomatic pericardial effusions Asymptomatic pericardial effusions that warrant a pericardial window for diagnosis Hemodynamically stable patients with an undiagnosed pericardial effusion (a thoracoscopic approach is ideal) Coexisting pericardial, pleural, or pulmonary pathology that requires diagnosis or therapy (a thoracoscopic approach is ideal) Known benign effusions that reaccumulate after aspiration Drainage of a purulent pericardial effusion Early fungal or tuberculous pericarditis in which resection of the pericardium is required to prevent future pericardial constriction Use as part of the mediastinal debridement, in patients with descending mediastinitis