Percutaneous pericardial window (balloon pericardiotomy): a Cath Lab 101 guide
Reviewed by Rodnie Oro, cath lab charge nurse · Last reviewed: October 2026 · Education only, not medical advice
Percutaneous pericardial window in one minute
What it is: using a balloon to make an opening (window) in the sac around the heart, so fluid that keeps coming back can drain into the chest and be absorbed.
Who it is for: people with recurring pericardial effusion, often related to cancer, who want to avoid surgery.
Main risks: fever, fluid around the lung, injury to the heart or lung, bleeding and infection.
Usually: under local anaesthetic and sedation, about an hour, with a drain afterwards.
On this page: What is a percutaneous pericardial window? · Who is it for? · When is it done? · Step by step · Recovery · Risks · Kit list · First time in the lab? · FAQ
What is a percutaneous pericardial window?
A pericardial window creates a permanent opening in the pericardium. It can be done by surgery or, less invasively, in the cath lab with a balloon (percutaneous balloon pericardiotomy).
- a needle and wire are placed in the fluid, as for pericardiocentesis
- a balloon is positioned across the edge of the pericardium and inflated to stretch an opening
- a drain is left in place
It is used when fluid keeps returning after drainage.
New to the acronyms? See the Cath Lab Abbreviations A–Z.
Who is it for?
It may be considered for people with:
- recurring pericardial effusion, often related to cancer
- people for whom surgery is higher risk
The decision is made by your heart team, who will talk through the reasons, the alternatives and the risks with you.
When is it done?
It can be planned in advance or done urgently. Before it, you usually have:
- blood tests, including kidney function and blood count
- an ECG, and often an echo or other scan
- a review of your medicines, especially blood thinners and diabetes medicines, as per centre protocol
- a chance to ask questions and give consent
Step by step
1. Getting ready
You lie on the X-ray table. ECG, blood pressure and oxygen levels are monitored. The skin over the access site is cleaned and numbed with local anaesthetic; some people also have light sedation, as per centre protocol.
2. Access
As for pericardiocentesis: a needle under echo from below the breastbone, then a wire into the pericardial space.
3. Making the window
- A. Access. A wire is placed in the fluid under echo.
- B. Balloon. A balloon is positioned across the edge of the sac.
- C. Inflate. It is inflated to create an opening; you may feel discomfort.
- D. Drain. A drain is placed and fluid removed.
4. Finishing
The drain is secured and connected to a bag, usually for a short time.
Recovery and aftercare
- Monitoring: rhythm, blood pressure and drain checks.
- Drain: often removed in a day or two.
- Chest X-ray: fluid around the lung can occur and may need treatment.
- Follow-up: echo and clinic review.
Call 999 if you have chest pain, breathlessness, fainting, signs of a stroke, or heavy bleeding or swelling at the access site.
Risks and complications
Your team will explain the risks that apply to you. Possible problems include:
- fever or pain
- fluid around the lung (pleural effusion)
- punctured lung
- injury to the heart or coronary artery
- bleeding or infection
- fluid returning
Cath lab kit list (printable)
Barts example kit list
An example from one UK centre, written generically. Every lab has its own protocol, and sizes and doses vary.
- pericardiocentesis set, per device and operator
- stiff guidewire, per operator
- balloon, size per device and operator
- echo machine
- drain and bag
- local anaesthetic and sedation, as per centre protocol
Procedural steps (Barts example)
- Echo; local anaesthetic; sedation
- Needle; wire into pericardial space
- Balloon across the pericardial edge
- Inflate; confirm with contrast
- Drain placed; fluid removed
First time in the cath lab?
đź’ˇ First-time tip
- Pain relief. Inflation can hurt; have analgesia ready.
- Mark the edge. Contrast helps show the waist on the balloon.
- Chest X-ray after. Check for lung fluid.
- Know the history. Most patients have had fluid drained before.
FAQ
Is it surgery?
No. It is done through a needle in the cath lab.
Will the fluid stop?
For many it reduces; your team will explain.
Is it painful?
You may feel discomfort during inflation.
Related Cath Lab 101 guides
Sources
All checked on 10 October 2026. Each page's own date is shown where it gives one.
- Adler Y, et al. 2015 ESC Guidelines for the diagnosis and management of pericardial diseases. Eur Heart J 2015;36(42):2921–2964. PubMed 26320112
- StatPearls (NCBI Bookshelf), search: percutaneous balloon pericardiotomy. ncbi.nlm.nih.gov/books
Disclaimer
Education only. This page is for general education for healthcare students, cath lab staff and curious readers. It isn't medical advice and doesn't replace advice from your own doctor, heart team or local unit protocols. Equipment and medicines are described generically. No product or manufacturer is recommended. If you think someone is having a heart emergency, call 999.
Disclosure: I work in the medical device industry. This page is independent education and isn't sponsored or reviewed by any company.
All diagrams on this page are original illustrations created for rodnieoro.com.
