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A Journal on Cardiac, Vascular and Thoracic Surgery

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The Journal of Cardiovascular Surgery 1999 December;40(6):909-13

language: English

Pericardial ­cysts of the med­i­as­ti­num

Cangemi V., Volpino P., Gualdi G.*, Polettini E.*, Frati R., Cangemi B., Piat G.

From the 1st Department of Surgery *1st Department of Medicine University “La Sapienza”, Rome, Italy


Pericardial ­cysts are an uncom­mon ­benign dis­ease. Their treat­ment, in the ­past, was ­based on exci­sion by thor­a­cot­o­my or, in select­ed cas­es, on per­cut­ane­ous aspi­ra­tion. The ­progress of vid­eo-assist­ed tho­ra­cos­co­py ­gave new pos­sibil­ities, but ­most sur­geons ­still con­sid­er the tho­rac­o­tom­ic ­approach as the treat­ment of ­choice. The aim of ­this ­study is to ­report our expe­ri­ence and to dis­cuss the ­role of dif­fer­ent ther­a­peu­tic pro­ce­dures in the man­age­ment of per­i­car­dial ­cysts. Between 1970 and 1996, 24 ­patients ­with per­i­car­dial ­cysts ­were treat­ed at the ­first Department of Surgery of the University of Rome «La Sapienza». Of 24 ­cysts, six ­were locat­ed in the ­right car­di­oph­ren­ic ­angle, ­three in the ­left car­di­oph­ren­ic ­angle, two in the sub­car­en­al are­as, one in the par­a­car­diac ­area and one on the pos­te­ri­or med­i­as­ti­num. Ten ­patients ­were asymp­to­mat­ic. Diagnosis was per­formed pre­op­er­a­tive­ly ­only in ­patients ­with ­cysts typ­i­cal­ly locat­ed in the car­di­oph­ren­ic ­angle. Twenty-three ­patients ­were sur­gi­cal­ly treat­ed by a stan­dard pos­te­ro­lat­er­al thor­a­cot­o­my or lim­it­ed thor­a­cot­o­my ­with spar­ing of mus­cles. One ­patient under­went CT- guid­ed trans­pa­rie­tal ­fine-nee­dle aspi­ra­tion. There ­were no cas­es of oper­a­tive mor­tal­ity. Morbidity was 12.5% and con­sist­ed of ­retained secre­tions, mod­er­ate hypox­e­mia and par­tial ate­lec­ta­sis. All ­patients ­were sub­mit­ted to a ­long-­term fol­low-up and no ­cyst recur­renc­es ­were ­found. We con­clude ­that exci­sion via thor­a­cot­o­my is an opti­mal treat­ment for per­i­car­dial ­cysts. Limited thor­a­cot­o­my ­with spar­ing mus­cles ­offers a ­good cos­met­ic ­result and a rap­id func­tion­al res­pir­a­to­ry recov­ery. Percutaneous ­cyst aspi­ra­tion may be, in select­ed ­patients, an attrac­tive alter­na­tive to sur­gery.

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