Name of the Procedure:

Cardiotomy, exploratory (includes removal of foreign body, atrial or ventricular thrombus); without bypass

Summary

An exploratory cardiotomy is a surgical procedure that involves making an incision into the heart to investigate and possibly remove foreign bodies or thrombi (blood clots) from the atria or ventricles. This procedure is performed without the use of a cardiopulmonary bypass machine.

Purpose

Exploratory cardiotomy is performed to identify and remove foreign objects or blood clots that may be causing complications within the heart. The goal is to restore normal heart function and prevent further complications, such as embolisms, strokes, or blockages of blood flow.

Indications

• Presence of foreign bodies in the heart, such as those resulting from traumatic injury.
• Detection of thrombi in the atria or ventricles through imaging studies.
• Symptoms of blocked or restricted blood flow within the heart.
• Cases where less invasive treatments (e.g., medication, catheter-based removal) are ineffective or inappropriate.

Preparation

• Patients may be required to fast for several hours before the procedure.
• Medications such as blood thinners may need to be adjusted or paused.
• Preoperative tests, including blood work, echocardiograms, and CT scans, might be conducted to assess the heart's condition.
• An intravenous line will be placed for medications and fluids.

Procedure Description

1. Incision: A surgical incision is made in the chest to access the heart.
2. Exploration: The heart is carefully examined to locate the foreign body or thrombus.
3. Removal: Surgical tools are used to remove the identified foreign body or thrombus.
4. Closure: The heart and chest are closed, and the incision is stitched up.
   • Tools: Standard surgical instruments, imaging technology for guidance.
   • Anesthesia: General anesthesia is administered to ensure the patient is unconscious and pain-free throughout the procedure.

Duration

The procedure typically takes between 2 to 4 hours but may vary based on the complexity and specific circumstances.

Setting

Hospital operating room.

Personnel

• Cardiothoracic surgeon.
• Surgical assistants.
• Anesthesiologist.
• Operating room nurses.
• Perfusionist (although bypass is not used, they may be on standby for emergencies).

Risks and Complications

• Infection
• Bleeding
• Heart rhythm abnormalities
• Stroke
• Damage to heart tissues
• Anesthesia-related complications
• Postoperative pain and discomfort

Benefits

• Removal of potentially life-threatening foreign bodies or thrombi.
• Relief from symptoms related to blocked heart chambers.
• Prevention of complications such as embolisms and strokes.
• Improved heart function.

Recovery

• Hospital stay of a few days to monitor heart function and wound healing.
• Pain management with prescribed medications.
• Instructions on wound care and activity restrictions.
• Follow-up appointments for assessment and possible further treatment.
• Gradual return to normal activities over several weeks.

Alternatives

• Medication to dissolve thrombi (fibrinolytics).
• Less invasive surgical techniques, such as catheter-based removal.
• Observation and monitoring if the risks of surgery outweigh the benefits.

Patient Experience

Patients will be under general anesthesia and will not feel anything during the procedure. Post-procedure, they may experience pain at the incision site, tiredness, and restricted activity. Pain management and supportive care will be provided to ensure comfort during recovery.