Successful resection of an epicardial cyst

Giant Epicardial Cyst Eroding Left Ventricular Wall Mimicking as Simple Pericardial Cyst

Epicardial cysts are rarer benign tumors than pericardial cysts. There have been few reports on surgical management of epicardial cysts. A 17-year-old normotensive boy presented with chest pain and palpitations, which on evaluation was found to be a mediastinal mass (pericardial cyst). Surgical resection of the cyst via thoracotomy was planned. The cyst was diagnosed as an epicardial cyst intraoperatively. However, due to the epicardial origin of cyst and posterior adhesions, resection was done via midline approach. The base was formed by visceral pericardium and eroding into myocardium of left ventricle, so the resection was concluded with on-pump surgery. In case of erroneous diagnosis or undesirable finding, a safer midline approach with on-pump surgery, as an alternative to minimally invasive approach for complicated epicardial cysts (erosion into ventricle/lying in close proximity to important structures or near to coronary arteries) should be considered.

Epicardial mesothelial cyst originating from the roof of the left atrium: a case report

Background

Epicardial mesothelial cysts are cysts that are attached to the epicardium within the pericardial cavity. Reports on epicardial mesothelial cysts are rare, and limited studies have investigated their surgical management. Here, we report the rare case of an epicardial cyst originating from the roof of the left atrium.

Case summary

A 73-year-old man with dyspnoea on exertion and lower limb oedema was diagnosed with a giant cyst (diameter, 7 cm × 4.5 cm) in the pericardial cavity using computed tomography. Off-pump surgery was performed with successful resection of the cyst with a pedicle connected to the roof of the left atrium. Histological examination confirmed the mesothelial origin of the tumour cells.

Conclusion

Cysts rarely develop within the pericardial cavity, especially an epicardial cyst. The few studies exploring this disease have suggested that patients with this condition may be asymptomatic or have mild breathlessness or cardiac tamponade, which might be occasionally or incidentally diagnosed. Sufficient preoperative evaluation, particularly involving the coronary artery, is essential, and a rational way of surgery should be planned considering all factors.

Off-Pump Resection of an Epicardial Cyst by Using a Minimally Invasive Approach

A 25-year-old man presented with palpitations and subsequently received a diagnosis of a large epicardial cyst (6.8 × 3.8 cm) originating from the left ventricle. The cyst compressed the left atrium and ventricle and led to left ventricular diastolic dysfunction. Contrast-enhanced chest computed tomography revealed that the circumflex artery passed over or through the cyst. We successfully resected the cyst without using cardiopulmonary bypass through a left mini-thoracotomy with thoracoscopic assistance. The diastolic dysfunction improved after the procedure. Most epicardial cysts may be treated in this fashion if the cyst is located in the left side of the heart.

Off-pump resection of a giant inflamed epicardial cyst

Background

Epicardial cysts are rarer benign tumors than pericardial cysts. There have been few reports on surgical management for epicardial cysts.

Case presentation

A 73-year-old woman with dyspnea on exertion had a giant cyst (12 × 10 cm in diameter) on preoperative computed tomography. Compression of the left atrium and ventricle by the cyst was considered to be the cause of her symptoms. The cyst was diagnosed with an epicardial cyst intraoperatively. Although the cyst adhered to surrounding tissues, it was successfully resected with off-pump surgery by using a heart positioner and an ultrasonic scalpel.

Conclusions

Surgeons should consider off-pump surgery as an alternative to video-assisted thoracoscopic surgery and on-pump surgery for complicated epicardial cysts.

Giant epicardial cyst presenting as acute cardiac tamponade in a 2-year-old boy

Cystic structures within the pericardial cavity are rare. They are divided into epicardial and pericardial variants. Pericardial and epicardial cysts rarely cause symptoms. This report describes a case of epicardial cyst with acute cardiac tamponade in a 2-year-old boy with no previous cardiac history who was transferred to our hospital because of hemodynamic instability. Emergency drainage of the pericardial effusion and complete excision of the cyst were performed through a median full sternotomy.

Epicardial cyst originating from right ventricle

Pericardial cysts are reported by some authors, but epicardial cysts are extremely rare. We report one case of epicardial cyst that was detected incidentally and was removed successfully. Furthermore, unusually, pathological examinations confirmed that the cyst wall was looked like a vessel wall.

Epicardial cysts: report of two rare cases

Epicardial cysts originating directly from the epicardium are seen very rarely. Complete surgical excision is recommended when these cysts are detected. If cysts compress surrounding vital structures, cardiopulmonary bypass (CPB) should also be considered. We report herein 2 cases of multiloculated epicardial cysts, both of which were successfully excised, 1 with CPB.