**Abstract**

Management of pericardial effusion is a common topic for cardiothoracic surgeons. From a surgeon's perspective, we would review and evaluate patients for surgical drainage. Besides discussing the frequent indications for performing pericardial window creation, we would go through the decision-making process during the perioperative management of these patients who might be critically ill. For example, regardless of whether surgery is for diagnostic or therapeutic reasons, the risks of surgery must be weighed against the benefits including the odds of quality of life across a reasonable life expectancy.

**Keywords:** pericardial window, surgical drainage
