DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Malignant pericardial effusion.
POSTOPERATIVE DIAGNOSIS: Malignant pericardial effusion.
PROCEDURE PERFORMED: Subxiphoid pericardial window.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
ANESTHESIA: General endotracheal.
COMPLICATIONS: None.
DRAINS: Two 32 French chest tubes.
INDICATIONS FOR PROCEDURE: This is a (XX)-year-old Hispanic male with a past medical history significant for metastatic small cell lung carcinoma, who presented with some symptoms of increasing shortness of breath and easy fatigability. Further workup noted that he had evidence of a large pericardial effusion with evidence of pericardial tamponade. The patient underwent pericardiocentesis and had the fluid drained and had indwelling catheter left in place. Initial drainage was bloody fluid that was about 600 mL. Over the weekend, there was evidence that the fluid was reaccumulating when we checked his CT scan of the chest. The patient is presenting to the OR now for subxiphoid pericardial window and drainage of this fluid.
DESCRIPTION OF PROCEDURE: The patient was identified and placed on the operative table in the supine position. General endotracheal anesthesia was induced. The chest and lower extremities were prepped and draped in the normal sterile fashion. The patient was given IV antibiotics prior to the start of the case.
A standard subxiphoid pericardial window incision was made, and dissection was carried down through to the level of the xiphoid process. We then removed the xiphoid and dissected down to the level of the pericardium. We then entered the pericardium and drained off about 600 mL of blood-tinged fluid from the pericardial sac. We did open up a large 4 x 4 cm window within the pericardium to drain all the fluid out.
Once this was done, we then checked the inside of the pericardium where we did feel some nodularity in there that probably was secondary to some tumor nodules. We did send some of the exudative tissue from the inside of the pericardial sac down for pathology. We sent the fluid off for culture as well as cytology. We then checked for evidence of any bleeding. When we were sure that there was none, we then placed a chest tube along the base of the heart as well as one anteriorly. We then sutured these in place.
We then injected 0.25% Marcaine in the wound and closed the wound in three layers using absorbable stitches. The wounds were cleaned and dried, and sterile bandages were placed. All needle, sponge, and instrument counts were correct at the end of the case. The patient tolerated the procedure well, will be extubated, and taken to the recovery room at this time.
