Pericardial-Peritoneal Window: A Novel Palliative Treatment for Malignant and Recurrent Cardiac Tamponade
A 61-year-old male had presented to the hospital with symptoms of chronic cough with expectoration and hemoptysis since 6 months. He complained of sudden onset breathlessness since last few days. On evaluation, conventional radiographs of the chest demonstrated an enlarged cardiac silhouette []. Contrast-enhanced computerized tomography (CECT) revealed disseminated lung cancer, bilateral pleural effusion, and massive pericardial effusion []. An echocardiogram was performed which had features of massive pericardial effusion (6 cm space between the two layers of pericardium) and right ventricle diastolic collapse. Pericardial fluid was aspirated thrice before a definitive surgical procedure was planned. Cytology of the peritoneal fluid showed signs of malignancy. Patient was diagnosed to have recurrent cardiac tamponade secondary to disseminated lung malignancy.\nIn view of recurrent cardiac tamponade and patient being in an already compromised state dying of disseminated disease, a definitive surgical procedure was planned. Surgical pericardial-peritoneal window was planned through a subxiphoid approach under local anesthesia.\nAfter the pericardial sac was exposed and the fluid evacuated, the diaphragmatic surface of the pericardium was examined. An opening of (4 × 4 cm) was created to join the pericardial and peritoneal cavities []. The cut edges of the pericardium, diaphragm, and peritoneum were sutured together with a few interrupted sutures. The dome of the liver prevents any abdominal viscera from herniating into the pericardial cavity. No drainage tubes are needed. The linea alba, subcutaneous tissues, and skin were closed in the usual manner. No complications were encountered and patient was discharged in 2 days. Patient experienced significant symptom amelioration after undergoing pericardioperitoneal fenestration.