A pericardial window is a cardiac surgical procedure to create a communication – or “window” – from the pericardial space. Drainage can be performed directly through a subxiphoid approach or indirectly into the pleural space or peritoneal cavity after pericardiotomy (the most common approach is the transpleural approach that can be achieved by either lateral thoracotomy or video-assisted thoracoscopy). During the procedure pericardial biopsy can be performed for the study of pericardial tissue [1].

A pericardial window by subxiphoid approach is usually done through a vertical lower chest incision, then the rectus abdominis is divided through the linea alba and the xiphoid process is exposed and incised or retracted (Fig. 7.2). After the incision of the pericardium, pericardial drainage is performed, and a single 24–32 F chest tube is placed.

The procedure is generally performed with general anaesthesia, and it is especially useful in case of infections in order to prevent the spread of the infection and pleural empyema (e.g. purulent pericarditis). However, a limitation of this approach is to gain a temporary drainage of pericardial space.

In case of persistent or recurrent pericardial effusions, a better option is to consider a pericardial window by a transpleural approach either by lateral thoracotomy or video-assisted thoracoscopy. A left side approach is usually favoured because more pericardium is present on the left side in levocardia. The procedure is completed through the insertion of 1 or 2 chest tubes in the pleural space. The thoracoscopic approach is less invasive but requires single lung ventilation.