Pericardial effusion is a collection of bloody fluid in the pericardium. It is a common finding after cardiac surgery. It is ranges from mild asymptomatic pericardial collection to cardiac tamponade.
The reported incidence of effusion after open heart surgery ranges from 4.7% to 85% and this may appear after few days of surgery or after discharge of the patient.
Mediastineal and pleural chest tubes are placed after cardiac surgery as a part of standard care. They allow drainage of any fluids from mediastineal space into the tubes. Unfortunately the patient usually lies in supine position, so the fluid collects posteriorly and not discharged into the tubes.
Early cardiac tamponade after open heart surgery is usually related to surgical bleeding or coagulopathy due to cardiopulmonary bypass (CPB), whereas late tamponade seems to be multifactorial in origin.
Chest radiography may show increase in the size of cardiac silhouette in cases with large effusion, so the echocardiography is the golden standard in detection and diagnosis pericardial collection.
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Pericardial window is a simple technique allows passage of fluid from limited pericardial cavity to the larger pleural cavity and reduce the incidence of echocardiographically defined pericardial effusion from 40% in a control group to 8% in a pericardiotomy group.
Pericardial window made by 4cm longitudinal incision parallel and posterior to the left phrenic nerve, extending from the left inferior pulmonary vein to the diaphragm prior to discontinuation of cardiopulmonary bypass as described in Mulay and Coworkers in 1995.
Pericardial window technique showing lower incidence of supraventricular arrhythmias, wound dehiscence, prolonged hospital stay and impaired functional recovery.
The present study assessed the efficacy of pericardial window technique in preventing post operative tamponade and effusion-related complications with open heart surgery.
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