Name of the Procedure:

Resection of Pericardial Cyst or Tumor

Summary

This surgery involves the removal of a cyst or tumor located within the pericardium, the double-walled sac containing the heart. It is typically performed to alleviate symptoms or prevent complications related to the growth of these abnormal structures.

Purpose

The resection of a pericardial cyst or tumor addresses conditions like chest pain, shortness of breath, or abnormal heart sounds caused by these growths. The primary goal is to remove the cyst or tumor to improve symptoms, prevent potential complications, and ensure detailed pathological evaluation to rule out malignancy.

Indications

• Symptomatic pericardial cysts or tumors (e.g., causing chest pain, coughing, or difficulty breathing)
• Asymptomatic but large cysts or tumors that have the potential for complications
• Suspicion of malignancy based on imaging studies

Preparation

• Fasting for at least 8 hours prior to surgery
• Pre-operative blood tests, ECG, and imaging studies (e.g., echocardiogram, CT scan, or MRI)
• Medication adjustments as per the physician’s instructions, especially blood thinners

Procedure Description

1. The patient is placed under general anesthesia.
2. An incision is made in the chest, commonly through a median sternotomy or thoracotomy.
3. The heart and pericardium are exposed, and the cyst or tumor is carefully identified.
4. The surgeon resects the cyst or tumor, ensuring as complete removal as possible without damaging surrounding tissues.
5. The surgical site is inspected for bleeding and other abnormalities.
6. The pericardium and chest are closed in layers, and a chest drain may be placed.
7. The patient is taken to a recovery area to be monitored closely.

Duration

The procedure typically takes between 2 to 4 hours, depending on the complexity.

Setting

The surgery is performed in a hospital operating room with access to full surgical facilities and postoperative care.

Personnel

• Cardiothoracic surgeon
• Anesthesiologist
• Surgical nurses
• Perfusionist (if cardiopulmonary bypass is needed)
• Surgical technologist

Risks and Complications

• Bleeding
• Infection
• Injury to the heart or surrounding structures
• Arrhythmias (irregular heartbeats)
• Recurrence of the cyst or tumor
• Pain at the incision site

Benefits

• Relief from symptoms caused by the cyst or tumor
• Prevention of potential complications like rupture or compression of heart structures
• Pathological assessment of the removed tissue to rule out malignancy

Recovery

• Initial recovery in the intensive care unit (ICU) for close monitoring
• Hospital stay ranging from 3 to 7 days
• Instructions for wound care and activity restrictions
• Follow-up appointments for evaluation and removal of any drains or stitches
• Gradual resumption of normal activities, typically within 4 to 6 weeks

Alternatives

• Observation and regular monitoring for asymptomatic, small cysts or tumors
• Minimally invasive drainage (aspiration) for cysts
• Medication management for symptom control in non-surgical candidates
• Pros: Less invasive options carry lower immediate risks.
• Cons: Higher chance of cyst or tumor recurrence, incomplete relief of symptoms, or missed malignancy.

Patient Experience

During the procedure, the patient will be under general anesthesia and will not feel pain. Post-operatively, patients might experience discomfort and pain at the incision site, managed with medications. They may feel tired and require support for daily activities initially. Gradual improvement in overall well-being is expected as recovery progresses.