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Giant Pericardial Cyst Compressing the Right Ventricle
IMAGES IN CARDIOTHORACIC SURGERY
Giant Pericardial Cyst Compressing the Right Ventricle Agata M. Lesniak-Sobelga, MD, PhD, Maria Olszowska, MD, PhD, Wieslawa Tracz, MD, PhD, Mieczyslaw Pasowicz, MD, PhD, Zbigniew Samitowski, MD, PhD, Piotr Pieniazek, MD, PhD, Piotr Klimeczek, MD, PhD, Robert Banys, Msc, Piotr Musialek, MD, PhD, Lukasz Tekieli, MD, and Jerzy Sadowski, MD, PhD
Fig 3. Fig 1.
Fig 2.
A
50-year-old man, who had been generally active and in good health his entire life, was referred to our department 4 months after laparoscopic cholecystectomy because of right ventricular failure with ascites. An electrocardiogram showed sinus rhythm, negative T waves in leads I, aVL, V1-V6, low voltage QRS in limb leads, and no conduction disturbances. Standard two-
Address correspondence to Dr Lesniak-Sobelga, Cardiac and Vascular Department, Institute of Cardiology, Jagiellonian University School of Medicine, John Paul II Hospital, 31-202 Krakow, ul. Pradnicka 80, Poland; e-mail: [email protected].
© 2008 by The Society of Thoracic Surgeons Published by Elsevier Inc
dimensional transthoracic echocardiography revealed an abnormal mass compressing the right ventricular free wall. Echocardiography imaging (Fig 1) from the subcostal view exhibited a large nonhomogenous mass (2.5 ⫻ 9.2 cm, red arrow) compressing the right ventricle (RV ⫽ right ventricle; LV ⫽ left ventricle). The restrictive pattern of the transtricuspid flow with an increase of early maximal velocity (early/atrial ratio, 2.43; deceleration time, 131 milliseconds) revealed the mechanism responsible for the right heart decompensation. No significant valvular abnormalities were identified. The chest roentgenogram revealed the right pleural effusion and the effusion in the left cardiophrenic angle. Cardiac dual-source computed tomography with threedimensional reconstruction volume-rendering technique demonstrated a giant paracardiac, well-delineated, capsulated hypodense mass (10.5 ⫻ 7.5 cm) with calcifications positioned anterior to the right ventricle (Fig 2). The heart and great vessels were otherwise normal. Conventional coronary angiography revealed the normal vessels. The patient was referred for a surgical removal of the cyst. Intraoperatively, a giant pericardial cyst filled with partly hemolyzed blood and fibrin (600 g total), causing cardiac compression, was found and removed (Fig 3). The anterior part of pericardium was calcified, and the calcifications were resected. The perioperative period was uneventful and the patient was discharged home on the day 8 after the operation. Ann Thorac Surg 2008;85:1811 • 0003-4975/08/$34.00 doi:10.1016/j.athoracsur.2007.12.043
FEATURE ARTICLES
Cardiac and Vascular Department and Department of Cardiovascular Surgery and Transplantation, Institute of Cardiology, Jagiellonian University School of Medicine, and Centre of Diagnosis, Prevention and Telemedicine, John Paul II Hospital, Krakow, Poland
Giant Pericardial Cyst Compressing the Right Ventricle Agata M. Lesniak-Sobelga, MD, PhD, Maria Olszowska, MD, PhD, Wieslawa Tracz, MD, PhD, Mieczyslaw Pasowicz, MD, PhD, Zbigniew Samitowski, MD, PhD, Piotr Pieniazek, MD, PhD, Piotr Klimeczek, MD, PhD, Robert Banys, Msc, Piotr Musialek, MD, PhD, Lukasz Tekieli, MD, and Jerzy Sadowski, MD, PhD
Fig 3. Fig 1.
Fig 2.
A
50-year-old man, who had been generally active and in good health his entire life, was referred to our department 4 months after laparoscopic cholecystectomy because of right ventricular failure with ascites. An electrocardiogram showed sinus rhythm, negative T waves in leads I, aVL, V1-V6, low voltage QRS in limb leads, and no conduction disturbances. Standard two-
Address correspondence to Dr Lesniak-Sobelga, Cardiac and Vascular Department, Institute of Cardiology, Jagiellonian University School of Medicine, John Paul II Hospital, 31-202 Krakow, ul. Pradnicka 80, Poland; e-mail: [email protected].
© 2008 by The Society of Thoracic Surgeons Published by Elsevier Inc
dimensional transthoracic echocardiography revealed an abnormal mass compressing the right ventricular free wall. Echocardiography imaging (Fig 1) from the subcostal view exhibited a large nonhomogenous mass (2.5 ⫻ 9.2 cm, red arrow) compressing the right ventricle (RV ⫽ right ventricle; LV ⫽ left ventricle). The restrictive pattern of the transtricuspid flow with an increase of early maximal velocity (early/atrial ratio, 2.43; deceleration time, 131 milliseconds) revealed the mechanism responsible for the right heart decompensation. No significant valvular abnormalities were identified. The chest roentgenogram revealed the right pleural effusion and the effusion in the left cardiophrenic angle. Cardiac dual-source computed tomography with threedimensional reconstruction volume-rendering technique demonstrated a giant paracardiac, well-delineated, capsulated hypodense mass (10.5 ⫻ 7.5 cm) with calcifications positioned anterior to the right ventricle (Fig 2). The heart and great vessels were otherwise normal. Conventional coronary angiography revealed the normal vessels. The patient was referred for a surgical removal of the cyst. Intraoperatively, a giant pericardial cyst filled with partly hemolyzed blood and fibrin (600 g total), causing cardiac compression, was found and removed (Fig 3). The anterior part of pericardium was calcified, and the calcifications were resected. The perioperative period was uneventful and the patient was discharged home on the day 8 after the operation. Ann Thorac Surg 2008;85:1811 • 0003-4975/08/$34.00 doi:10.1016/j.athoracsur.2007.12.043
FEATURE ARTICLES
Cardiac and Vascular Department and Department of Cardiovascular Surgery and Transplantation, Institute of Cardiology, Jagiellonian University School of Medicine, and Centre of Diagnosis, Prevention and Telemedicine, John Paul II Hospital, Krakow, Poland