Publication Date
8-1-2017
Journal
The Texas Heart Journal
DOI
10.14503/THIJ-16-6011
PMID
28878585
Publication Date(s)
August 2017
Language
English
PMCID
PMC5577957
PubMedCentral® Posted Date
8-1-2017
PubMedCentral® Full Text Version
Post-Print
Published Open-Access
yes
Keywords
Carcinoma, renal cell/complications/surgery; combined modality therapy; coronary thrombosis/pathology; heart neoplasms/secondary/surgery; intraoperative complications/prevention & control; monitoring, intraoperative; neoplasm invasiveness; thrombectomy/methods; treatment outcome; vena cava, inferior
Copyright
This work is licensed under a Creative Commons Attribution-NonCommercial-No Derivative Works 4.0 International License.
Abstract
Invasion of a renal cell carcinoma thrombus into the inferior vena cava and right atrium is infrequent. Reaching and completely excising a tumor from the inferior vena cava is particularly challenging because the liver covers the surgical field. We report the case of a 61-year-old man who underwent surgery for a renal cell carcinoma of the right kidney that extended into the inferior vena cava and right atrium. During dissection of the liver to expose the inferior vena cava, transesophageal echocardiograms revealed right atrial mass migration into the tricuspid valve. On emergency sternotomy, the tumor embolized into the main pulmonary artery. We used a selective upper-body perfusion technique involving moderately hypothermic cardiopulmonary bypass, cardioplegic arrest, and clamping of the descending aorta, which provided a bloodless surgical field for precise removal of the mass and resulted in minimal blood loss. Our technique might be useful in other patients with tumor thrombus extending into the right atrium because it reduces the need for transfusion and avoids the deleterious effects of deep hypothermic circulatory arrest. Our case also illustrates the importance of continuous transesophageal echocardiographic monitoring to detect thrombus embolization.