33020 Pericardiotomy for removal of clot or foreign body (primary procedure)

Name of the Procedure:

Pericardiotomy for Removal of Clot or Foreign Body (Primary Procedure)

Summary

A pericardiotomy is a surgical procedure where an incision is made in the pericardium (the sac surrounding the heart) to remove clots or foreign bodies. This is typically done to relieve pressure on the heart or to prevent complications from trapped material.

Purpose

The procedure addresses conditions where clots or foreign objects are causing issues within the pericardial sac. The main goals are to relieve symptoms such as chest pain or breathing difficulties, and to prevent further complications related to impaired cardiac function.

Indications

• Persistent chest pain unresponsive to other treatments.
• Diagnosed pericardial effusion (excess fluid around the heart) with clots.
• Suspected or confirmed presence of foreign objects in the pericardial cavity.
• Symptoms of cardiac tamponade (pressure on the heart) such as low blood pressure, shortness of breath, or fainting.

Preparation

• Patients are typically required to fast for at least 8 hours before the procedure.
• Medication adjustments may be necessary, especially if the patient is on blood thinners.
• Pre-procedural diagnostic tests might include echocardiograms, chest X-rays, and blood tests.

Procedure Description

1. The patient is placed under general anesthesia.
2. A small incision is made in the chest to access the pericardium.
3. The pericardium is carefully opened to visualize and access the clot or foreign body.
4. The clot or foreign object is meticulously removed.
5. The pericardium and then the skin incision are closed with sutures.
6. A drainage tube may be placed temporarily to allow any excess fluid to drain from the pericardial space.

Duration

The procedure typically takes 1 to 2 hours, depending on the complexity.

Setting

This procedure is performed in a hospital operating room.

Personnel

• Cardiothoracic surgeon
• Anesthesiologist
• Surgical nurses
• Possibly a perfusionist (if needed)

Risks and Complications

• Infection at the incision site
• Bleeding
• Injury to the heart or surrounding tissues
• Anesthesia-related complications
• Long-term complications such as constrictive pericarditis (stiffening of the pericardium)

Benefits

• Immediate relief from symptoms caused by pericardial effusion or tamponade.
• Prevention of further cardiac complications.
• Improved quality of life post-recovery.

Recovery

• Patients usually stay in the hospital for a few days for monitoring and recovery.
• Pain management will be provided with medications.
• Physical activity may be restricted for a few weeks.
• Follow-up appointments are necessary to ensure proper healing and to monitor heart function.

Alternatives

• Pericardiocentesis (drainage of fluid with a needle).
• Medications to manage symptoms and underlying conditions.
• Observation in less severe cases.
• Each alternative has its pros and cons, including effectiveness and invasiveness.

Patient Experience

• The patient will be under general anesthesia during the procedure and will not feel anything.
• Post-procedure, pain and discomfort at the incision site can be expected but will be managed with pain relief medications.
• The patient might feel tired and weak for a few days, gradually improving with rest and proper care.