PMC5591449_01
(A) Contrast enhanced angio CT demonstrating an anterior mass obstructing the right ventricular inflow tract. (B) The mass has two calcified layer and some fluid collection extending from the diaphragmatic aspect to the right ventricular infundibulum. (C) Preoperative echocardiograohy demonstrating the anterior localized mass. Legend: CP = Constrictive pericarditis, RV-Right ventricle.
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A contrast enhanced angio computerized tomography clearly demonstrated a large spherical mass about 11 x 9 x 4 cm in the anterior pericardium, presenting as a mediastinal tumor and compressing right ventricle inflow tract (Fig. 1A and B). A transthoracic echocardiogram identified the anterior cardiac mass and revealed again the presence of partial compression of the right ventricular free wall (Fig. 1C).
(A) Intraoperative view of the anterior calcified mass extension. (B) The dissection was started from the anterior surface of the right ventricle. (C) The outer calcified layer was opened and the contents of the mass appeared like old coagulated blood. D. The amorphous tissue was evacuated with a sterile spoon.
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Upon gross examination before removal, the mass was noted to extend from the diaphragm to the top of the right atrium, and from the right phrenic nerve to the anterior interventricular groove and right ventricular infundibulum (Fig. 2A). The dissection was started from the anterior surface of the right ventricle toward the mass on the right atrioventricular groove (Fig. 2B). This layer was easily opened and the contents of the mass appeared like old coagulated blood (Fig. 2C) which was evacuated with a sterile spoon (Figs. 2 D and 3 A).
(A) The empty cavity of the calcified pericarditis before the total removal. (B) The inferior calcified layer of the pericardial mass which was extremely adherent with the epicardium, was carefully excised. (C) The removed mass consisted solely of thickened and fibrotic pericardium with nodular calcifications.
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Then the inferior calcified layer of the pericardial mass which was extremely adherent with the epicardium, was carefully excised, without the use of cardiopulmonary bypass, from the origin of the great vessels to the diaphragm and all areas between the right and left phrenic nerves (Fig. 3B). The removed mass consisted solely of thickened and fibrotic pericardium with nodular calcifications (Fig. 3C) and coagulated blood.