PSReport 0907
PATIENT NAME:
SURGEON:
DATE OF SURGERY:
Junice Monroe
Megan Lewis, MD
02/11/20XX
PREOPERATIVE DIAGNOSIS
Malignant cardiac tumor.
POSTOPERATIVE DIAGNOSIS
Malignant cardiac tumor.
NAME OF OPERATION
1. Removal of cardiac tumor.
2. Left atrial reconstruction.
3. Patch closure of atrioseptal defect and patent foramen ovale.
ANESTHESIA
General endotracheal.
INDICATIONS
This 65-year-old female presented with evidence of congested failure and left lower lobe atelectasis. She
was found to have a cardiac tumor on CT scan and echo. Angiography showed some coronary vessels
from the circumflex feeding the tumor mass.
OPERATIVE FINDINGS
There were 2 distinct tumor masses. One was outside the heart occupying the pericardial space just
behind the left ventricle. This mass measured about 5 x 8 cm in size. Its pedicle was coming off the
posterior wall of the left atrium in the vicinity of the atrioventricular groove. Inside the left atrium, there
were two areas of tumor, one of them in continuity with the extracardiac mass extending into the vicinity
of the left inferior pulmonary vein. This was a trilobar mass. In addition, there was a 2nd tumor in the
area of the interatrial septum near the mitral valve annulus. This was a smaller tumor, measuring about 1
x 1½ inches in diameter. There was also some fibrinous pericarditis, and tumor cells where found in some
of this reactive tissue. The frozen section confirmed the presences of a malignant tumor, but the type
could not be specified by the pathologist.
PROCEDURE
The patient was prepared and draped in the usual sterile fashion. A median sternotomy was made, and she
was placed under cardiopulmonary bypass using a high cannula in the superior vena cava. Pacifico-type,
and another cannula directly into the inferior vena cava. The left pulmonary artery was vented. The aorta
was cross-clamped and infused with cold-blood cardioplegic solution. The pedicle of the extracardiac was
delineated. Once this was done, a left atrial incision was made between the right superior and inferior
pulmonary vein extending under the superior vena cava to facilitate exposure. The mass that was attached
to the interatrial septum and a segment of the interatrial septum were excised. This complete excision
created an interatrial septal defect. In addition, there was a patent foramen ovale of congenital origin.
The mass that was near the area of the left inferior pulmonary vein was resected. This mass was partially
obstructing this orifice but did not grow into it. It was excised as much as possible and then removed from
outside the heart by sharp and blunt dissection.
(continued)
OPERATIVE REPORT
PATIENT NAME: Junice Monroe
DATE OF SURGERY: 02/11/20XX
Page 2
Upon excision of the mass from the inside of the heart, an orifice was made in the free wall of the left
atrium posteriorly. In order to secure closure in this area, the tumor mass was resected a little farther
toward the inferior vena cava, and then the defect was repaired with a patch of autologous fresh
pericardium using continuous 4-0 Prolene. This provided satisfactory closure, but to secure hemostasis,
pledgeted stiches were passed near the AV groove. The interatrial septal defect was closed with a patch of
autologous pericardium, and this repair included a patent foramen ovale. The left atriotomy was then
closed with continuous 3-0 Prolene, and this was followed by closure of the right atriotomy that was used
to close the interatrial septal defect.
Perfusion was discontinued after rewarming without any difficulty. There was preservation of sinus
rhythm. Intraoperative transesophageal echo was used to assess mitral valve function, and the patient was
found to have 1+ mitral insufficiency, which was quite acceptable. The usual maneuvers for removal of
intracardiac air were performed, and profusion was discontinued. Three chest tubes were inserted, one of
them directly into the left pleural space. The right pleural space was also opened to communicate with the
pericardial area. Temporary pacing wires were attached to the right atrium and ventricle, and the incision
was closed with stainless steel monofilament wire for the sternum and Vicryl for the soft tissues and skin.
Perfusion time 152 minutes. Cross-clamp time 76 minutes. Lowest systemic temperature 29 degrees.
Myocardial temperature 6 degrees.
The operation was well tolerated, and the patient was transferred to the intensive care unit in good
condition.
________________________
Megan Lewis, MD
ML/ps
D: 02/11/20XX
T: 02/13/20XX