Dr Saumya Sekhar Jenasamant CVTS, Heart & Lung Transplant

A thymus and mediastinal mass excision, as well as a pericardiectomy, are surgical procedures involving the thoracic (chest) region. Here’s a brief overview of each:

Thymus and Mediastinal Mass Excision

• Thymus Gland: A small organ located in the upper chest, beneath the breastbone. It is part of the immune system and is involved in the development of T-cells (a type of white blood cell).
• Mediastinum: The central compartment of the thoracic cavity, containing the heart, thymus, parts of the esophagus, trachea, and other structures.
• Mass Excision: This procedure involves the surgical removal of abnormal growths or masses in the mediastinum, including the thymus gland. These masses can be benign (non-cancerous) or malignant (cancerous). The surgery is typically performed to alleviate symptoms or to remove cancerous tissue.

Pericardiectomy

• Pericardium: A double-walled sac that surrounds the heart, providing it with protection and support.
• Pericardiectomy: This is the surgical removal of a part or the entire pericardium. It is often performed to treat conditions such as constrictive pericarditis (where the pericardium becomes thickened and restricts heart function) or recurrent pericardial effusion (accumulation of fluid around the heart).

Indications for Surgery

• Thymus and Mediastinal Mass Excision: Indicated for the removal of thymomas (tumors of the thymus), other mediastinal tumors, or cysts that may cause symptoms such as chest pain, cough, or shortness of breath.
• Pericardiectomy: Indicated for constrictive pericarditis, recurrent pericardial effusion, or other pericardial diseases that impair heart function.

Procedure Overview

• Preoperative Preparation: Includes diagnostic imaging (like CT or MRI scans), lab tests, and possibly a biopsy of the mass.
• Anesthesia: General anesthesia is used to ensure the patient is asleep and pain-free during the procedure.
• Surgical Approach: Access to the chest can be gained through various techniques such as a sternotomy (vertical incision along the breastbone) or thoracotomy (incision between the ribs). Minimally invasive techniques, such as video-assisted thoracoscopic surgery (VATS) or robotic-assisted surgery, may also be used.
• Postoperative Care: Patients typically spend time in the ICU for monitoring, followed by recovery in the hospital. Pain management, respiratory therapy, and gradual return to normal activities are part of the recovery process.

Risks and Complications

• Common Risks: Infection, bleeding, pain, and reaction to anesthesia.
• Specific Complications: For thymus and mediastinal mass excision, there is a risk of damage to nearby structures such as blood vessels, nerves, or the heart. For pericardiectomy, potential complications include heart rhythm disturbances, fluid accumulation around the lungs (pleural effusion), or impaired heart function.

These procedures are complex and require a skilled surgical team, often involving cardiothoracic surgeons. If you have any specific questions or need more detailed information, feel free to ask!