• Percutaneous balloon pericardiotomy uses a balloon-tipped catheter to create a tear in the wall of the pericardium. Fluid drains through the tear and into the pleural cavity, which can accommodate a considerably larger volume of fluid. The procedure only requires local anesthesia. It is used most commonly in patients with cancer where the chief concern is the remaining quality of life.

  • Surgical pericardiotomy involves giving the patient general anesthesia, so the patient “sleeps” through the procedure. The surgeon then makes an incision in the chest and pericardium to gain access for the drainage tube. Surgery is more likely if the fluid continues to accumulate, if the cause of the fluid accumulation remains obscure, or if the removal of the pericardial sac becomes necessary. This procedure is often preferred over pericardial needle aspiration, particularly when diagnosis or treatment is not an emergency. The advantages include direct visualization of the pericardium by the surgeon, making the procedure safer in general than percutaneous drainage. Also, the procedure allows for a specimen of the pericardium to be evaluated by a pathologist for evidence of cancer or infection. Analysis of both a pericardium sample and collected fluid greatly improves the reliability of a diagnosis made by analysis of the collected fluid alone. Finally, surgical pericardiotomy allows continued draining of the pericardium long after the procedure, which reduces the likelihood of a recurrent effusion.

  • Pericardiectomy is a type of operation in which part of the pericardium is surgically removed. This procedure may be done if scarring is present with cardiac tamponade. It is usually performed only in severe cases.