Subxiphoid Pericardial Window

Subxiphoid Pericardial Window

David Ray Velez, MD

Table of Contents

Background
Subxiphoid Procedure
Alternative Approaches

See Also:
*See Cardiac Laceration

Background

Definition: A Surgical Procedure to Create an Opening in the Pericardium to Evaluate for Pericardial Fluid/Blood

Used in Trauma as a Diagnostic Tool to Evaluate for Cardiac Injury (Not Therapeutic)

Outside of Trauma it Can be Used to Drain a Pericardial Effusion

Subxiphoid Procedure

Procedure

  • Incision: 8-10 cm Midline Incision Over the Xiphoid
  • Dissect Toward the Cardiac Impulses to Find the Pericardium
    • May Require Resection of the Xiphoid Tip if Obstructing the View
    • Will See Preperitoneal Fat but Take Care Not to Enter the Peritoneum
  • Grasp the Pericardium Between Two Alice Clamps
  • Make a 1-2 cm Longitudinal Incision in the Pericardium Between the Clamps
    • Ensure Adequate Local Hemostasis Before Making a Pericardial Incision to Avoid Confusing the Interpretation of Results
  • Flood the Field/Pericardial Sac with Fluid
  • Suction Fluid and Examine the Quality
  • If Negative: Close the Pericardium and Skin

Results

  • Positive: Bloody Fluid (Caution: Clotted Blood May Be Dry on Incision)
  • Negative: Clear or Straw-Colored Fluid

Hemopericardium (Positive Pericardial Window) Generally Necessitates Median Sternotomy to Evaluate and Manage Cardiac Injury

Pericardial Window 1

Alternative Approaches

Anterior Parasternal Pericardial Window – Performed Through a 6-8 cm Vertical/Curvilinear Incision Along the Left Parasternal Border to Create an Anterior “Mini-Thoracotomy” at the 4th-5th Rib Space to Access and Create the Pericardial Window

Transdiaphragmatic Pericardial Window – Can Be Performed During Laparotomy for Other Reasons by Creating an Incision Through the Diaphragm to Access and Create the Pericardial Window

Anterolateral Left Thoracotomy – Can Be Performed During Thoracotomy for Other Reasons to Access and Create the Pericardial Window

Video-Assisted Thoracoscopic Surgery (VATS) Pericardial Window – A Minimally Invasive Technique Using a Thoracoscope Inserted Through into the Left Pleural Space to Access and Create the Pericardial Window (Not Used in Trauma)

References

  1. Toth I, Szucs G, Molnar TF. Mediastinoscope-controlled parasternal fenestration of the pericardium: definitive surgical palliation of malignant pericardial effusion. J Cardiothorac Surg. 2012 Jun 19;7:56. (License: CC BY-2.0)