Pericardial Window in Dogs

A pericardial window is a surgical procedure that involves removing a small portion, usually four to five centimeters, of the pericardium, the fibrous sac that protects the heart. This is done to resolve pericardial effusion, or the buildup of fluid in the pericardium. It is a quicker and less invasive procedure compared to other cardiac procedures.

This procedure should not be confused with pericardiectomy, which is the total removal of the pericardium. However, a pericardial window may also be made in dogs undergoing partial pericardiectomy.

A thoracoscope, which is a specialized camera used to visualize the heart, is used to guide this procedure. This means that the surgeon will not open the heart. However, if severe complications occur during surgery, the surgeon may need to perform an open thoracotomy. The procedure steps for creating a pericardial window are detailed below.

1. A veterinarian will take blood tests prior to surgery to ensure anesthetization is safe for the dog.
2. An ECG will be taken before general anesthesia is administered.
3. If the pericardial effusion is significant enough to decrease visualization, some of the fluid may be removed through pericardiocentesis. This procedure involves removing the fluid using a special needle.
4. The operative area is shaved, cleaned, and clipped.
5. The surgeon will create at least three ports, which are small incisions into the chest, through which the camera and other surgical instruments are inserted.
6. The camera is placed into one of the ports.
7. Endoscopic graspers, used to grip the pericardium, are inserted through one of the ports. Maintaining a firm grasp on the pericardium may take a few moments, since the heart is always beating.
8. The pericardium is pulled away from the heart
9. Endoscopic scissors are used to cut the selected portion of pericardium.
10. This will release the fluid, which will be collected via suction.
11. The portion of pericardium is then removed with endoscopic scissors.
12. A catheter is put in place while the port incisions are sutured. The catheter is removed after closure.
13. The dog will be hospitalized for approximately twenty-four hours, or according to surgeon instructions. The removed pericardium and fluid are sent to a laboratory for analysis.

Pericardial window is considered effective in resolving pericardial effusion. The buildup of fluid almost always recurs in dogs that do not receive a pericardial window. It is also less invasive than other procedures, and dogs are often released from the hospital as quickly as one day after surgery. Some dogs return to normal activity within three months after surgery. Unfortunately, pericardial window is often a palliative treatment – that is, done to relieve pain rather than cure the underlying condition – in dogs diagnosed with cardiac cancers.

Owners should follow their surgeon’s recovery instructions very carefully. Analgesics and antibiotics are administered to prevent postoperative infection and manage pain. Dogs should rest, not engaging in any exercise, for up to six weeks after surgery, or as instructed by the surgeon. A bandage will be applied to the surgery site until the sutures are removed within fourteen days. This should be kept clean and dry to prevent infection. Upon changing the bandage, owners should inspect the suture site to ensure no swelling, drainage, or bleeding has occurred. If this occurs, owners need to contact their veterinarian immediately. A follow-up appointment will take place two weeks after surgery to evaluate cardiac function and remove sutures. Follow-up appointments will be scheduled as needed to conduct additional ECGs and monitor cardiac function.

The cost of pericardial window will vary based on standards of living and additional treatment costs. On average, the price of pericardial window ranges from $500 to $1,000.

Thoracoscopic cardiac procedures decrease the risk of intraoperative soft tissue trauma. It also causes less pain than open procedures, and provides better visualization of the heart and pericardium. Dogs recover quickly from the procedure and are allowed to go home soon after surgery. It also carries a lower morbidity rate compared to open heart surgery.

Although pericardial window is less invasive and more effective in resolving pericardial effusion than other cardiac procedures, complications are possible, and may include:

• Herniation of the heart through the window, particularly if the window is large
• Closure of the window over time

If the window closes, a second surgery will be required. This may involve creating a new window, or removing part of all of the pericardium. Additionally, thoracoscopic equipment is expensive, and may not be available at all veterinary hospitals.

Cardiac conditions are often difficult to prevent, particularly cancer and idiopathic pericardial effusion. Owners should make sure their dogs do not engage in activities that may cause traumatic injury to the heart. If owners notice signs of bacterial or fungal infection, they should seek immediate veterinary attention.