الفهرس 
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Abstract
The new diagnostic strategies have improved the ability to assess the presence and the amount of pericardial effusion, the Echocardiography is the corner stone in the management, multimodal imaging strategies specially computed tomography are dependable.
Pericardial effusion is classified by the volume of effusion.
The optimal therapy for symptomatic pericardial effusions remains controversial. In general, there are surgical based approaches and percutaneous-based approaches to pericardial fluid drainage.
The treatment by surgical subxiphoid is directed at the primary disease in patients with a small amount of effusion without symptoms. In contrast, percutaneous pericardiocentesis is performed for patients who are vitally unstable and with a massive amount of effusion to prevent cardiac tamponade.
Video-assisted thoracoscopic (VATS) pericardiotomy has gained popularity as a minimally invasive approach. VATS allows for visual evaluation of the pericardium and is used when the diagnosis of pericardial effusion has remained undiagnosed despite previous, less-invasive tests. It is also used to drain the excess fluid and prevent its reaccumulation.
Summary of our results:
• All the results are comparable with other studies as regard demographic data , time of the procedure , chest tubes drainage duration , superficial wound infection , intermediate care unite , total hospital stay and recurrence of the pericardial effusion .
• VATS pericardiotomy and open window offers best safety accessibility but costy and lenghthy .
• Combined procedures may be needed for single case to obtain safty , diagnosis and complete drainage with prevention of recurrence .
Conclusion
In pericardial effusion patients, pericardial window surgery in the modern era is an effective technique for the drainage of a large pericardial effusion. Compared to the thoracotomy technique, a window performed via a video-assisted thoracoscopic (VATS) pericardiotomy leads to less postoperative pain and complications including infections and with lower ICU and in-hospital duration . With significantly lower recurrence in VATS pericardiotomy and open surgical drainage compared to percutaneous pericardiocentesis group and subxiphoidal drainage group . This may shape a clinician’s management of a symptomatic pericardial effusion.
With the increasing of the familialty and confidence in epicardial access the volume and complexity of procedures has increased to obtain the best management of each single case of pericardial effusion and with the intimate knowledge of the pericardial anatomy which is essential to successfully performing these procedure and decrease the rate of complications .
On the other hand multimodality imaging has improved our ability to understand the pericardial anatomy and physiology and planning to perform these procedures and the management of the complications .
Limitations
● It was a single centric study.
● Relatively small sample size.
● Short follow-up period.
Recommendation
● Further with multi-centric with larger sample size and longer follow-up period are needed.
● Additional prospective studies with longer follow up period are needed to compare between pericardial window surgery and pericardiocentesis
● video-assisted thoracoscopic (VATS) pericardiotomy could be effective for management of pericardiac effusion.