CVSA’s PA Thorn and Dr. Mohan Assist on Removal of Giant Thoracic Tumor

With CVSA’s Dr. Mohan serving as the Surgical First Assist and PA Thorn serving as the Surgical Second Assist, a multi-disciplinary group of cardiothoracic, vascular and thoracic surgical teams work together to excise a massive mediastinal dysgerminoma with the patient in severe cardiopulmonary distress.

Patient: 23yM

Dx: Malignant massive Germ Cell Tumor (GCT) 16cm x 14cm x 15cm

Pre-Op Treatment: One Cycle of PEB Chemotherapy

Imminent Distress: Patient flown in due to worsening clinical condition:

• LVEF (28)

• Epathic Failure: SGPT 444UI/L and LDH 460UI/L

• Respiratory Distress: Abg pO2 55mmHg / O2 Sat 60%

• Directly admitted to CVICU due to suspected cardiovascular decompression

Surgical Strategy: Clamshell Thoracotomy w/ Potential Median Sternotomy

Upon entry, the team experienced full cardiopulmonary collapse and had to begin immediate open cardiac massage in an attempt to maintain critical perfusion. As cardiac massage was ongoing, Dr. Thorn assisted the lead attending with gaining full exposure to the chest cavity, including a bilateral clamshell incision and median sternotomy. PA Thorn assisted with manually retracting the chest wall to enable dissection and ongoing cardiac massage. Eventually, the patient was stabilized as the massive tumor was removed and the lung was reinflated. The patient is now undergoing chemotherapy and further operative intervention is planned. The value-add of Dr. Mohan and PA Thorn to this multi-disciplinary surgical team shows how CVSA can add value in these complex thoracic pathology cases with patients in extreme duress.