33025 Creation of pericardial window or partial resection for drainage

Name of the Procedure:

Creation of pericardial window or partial resection for drainage, also known as pericardial fenestration or pericardiectomy.

Summary

The procedure involves creating a small opening in the pericardium (the sac surrounding the heart) to drain excess fluid that can accumulate around the heart. This can relieve pressure and improve heart function.

Purpose

This procedure is performed to address conditions that cause fluid buildup (pericardial effusion) around the heart. The primary goals are to relieve symptoms, prevent complications, and improve heart function.

Indications

• Symptoms of pericardial effusion: chest pain, shortness of breath, swelling of the abdomen or legs
• Pericardial tamponade (a life-threatening condition)
• Persistent or recurrent pericardial effusion despite medical treatment
• Suspicion of infection, cancer, or other underlying causes of effusion

Preparation

• Patients may be instructed to fast for 6-8 hours before the procedure.
• Medications might need adjustment, particularly blood thinners.
• Pre-procedure tests may include blood tests, ECG, echocardiogram, and possibly a chest X-ray or CT scan.

Procedure Description

1. The patient is administered general anesthesia or local anesthesia with sedation.
2. A surgical incision is made either below the sternum or between the ribs on the left side.
3. A small window is cut in the pericardium to allow fluid to drain into the chest cavity, where it can be reabsorbed or removed through a chest tube.
4. The incision is then closed with stitches.

Tools used include scalpels, surgical scissors, and possibly a thoracoscope if minimally invasive techniques are employed.

Duration

The procedure typically takes 1-2 hours.

Setting

It is usually performed in a hospital operating room.

Personnel

• Cardiothoracic surgeon
• Anesthesiologist
• Nursing staff
• Surgical technicians

Risks and Complications

• Infection
• Bleeding
• Injury to the heart or surrounding organs
• Reaction to anesthesia
• Recurrence of fluid accumulation
• In rare cases, more serious complications like arrhythmias or heart damage

Benefits

• Relief from symptoms of pericardial effusion
• Prevention of pericardial tamponade
• Improved heart function
• Rapid symptom relief usually within a few days

Recovery

• Patients typically stay in the hospital for 1-3 days post-procedure.
• Pain management with medications.
• Instructions may include avoiding heavy lifting and strenuous activities for several weeks.
• Follow-up appointments to monitor recovery and ensure the fluid does not reaccumulate.

Alternatives

• Pericardiocentesis (needle drainage)
  • Less invasive but may be less effective for recurrent effusions.
• Medical management with anti-inflammatory drugs
  • May be effective for mild conditions but not for significant effusions.
• Pericardiectomy (complete removal of the pericardium)
  • More extensive surgery with longer recovery time, reserved for severe cases.

Patient Experience

Patients will be under anesthesia during the procedure and should not experience pain. Post-procedure, there may be discomfort at the incision site, manageable with pain medications. Over time, most patients feel significant relief from their prior symptoms and can resume normal activities after recovery.