INFRARENAL INFERIOR VENA CAVA CANNULATION DURING THE RESECTION OF RENAL TUMORS EXTENDING INTO THE RIGHT HEART – NO NEED FOR HYPOTHERMIC TOTAL CIRCULATORY ARREST

Introduction: Tumors which most frequently metastasize to the heart include: malignant melanoma, lung cancer, breast cancer, ovarian cancer, kidney cancer, leukemia, lymphomas and esophageal cancer. Purpose: The purpose of this paper was clinical analysis of a group of patients operated in deep hypothermic circulatory arrest due to tumors of the right atrium and the inferior vena cava. Material and method: The study covered 7 patients operated at the Cardiac Surgery Clinic with a cardiac tumor diagnosed on the basis of an echocardiographic assessment in the years 2012–2019. Before qualifying for surgical treatment, each patient underwent: thorough interview and physical examination, 12-lead ECG, laboratory tests and echocardiography. Patients additionally underwent: computed tomography of the chest or abdomen, magnetic resonance imaging and coronary angiography on the basis of which patients with significant coronary artery changes underwent simultaneous coronary artery bypass graft. After preparation, the tumor was excised from the vena cava and right atrium with simultaneous removal of the primary tumor, most often kidney cancer. Early and distant results of treatment were analyzed in the examined group of patients to determine the following endpoints: hospital mortality and survival after surgery: after 3 months and 12 months. Results: Of all operated patients: 2 individuals died in the early postoperative period due to hemorrhagic complications (hospital mortality - 28.6%), and 5 patients (71.4%) were discharged from the Clinic in a good general condition. In total, 3-month survival was 71.4%, and 12-month survival amounted to 28.6%. Conclusions: Surgeries are very complex and challenging, and usually take on average 8-10 hours. It can improve the outcomes of palliative oncological treatment, better physical function (cardiovascular fitness) and extend life from several months to several years in more than 2/3 patients.

Download Full-text

Intravascular leiomyomatosis with cardiac extension: a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytac001 ◽

2022 ◽

Author(s):

Einat Shaked ◽

Ram Sharoni ◽

Debra Gershov West ◽

Eli I Lev

Keyword(s):

Inferior Vena Cava ◽

Clinical Condition ◽

Heart Surgery ◽

Inferior Vena ◽

Multimodality Imaging ◽

Open Heart Surgery ◽

Vena Cava ◽

Abdominal Ultrasound ◽

Right Heart ◽

The Right

Abstract Background Intravascular leiomyomatosis with intracardiac extension is a rare benign tumor seen exclusively in women, characterized by proliferation of uterine smooth muscle cells through the venous circulation into the inferior vena cava and the right heart chambers. Case summary A 47 years old women with history of previous hysterectomy due to myomatosis, presented with nausea, anorexia and bilateral lower limb swelling over the preceding two months. An outpatient abdominal ultrasound discovered a mass in the Inferior vena cava. Echocardiogram and Computed tomography demonstrated a large intravascular mass extending from the pelvis to the right heart chambers. The tumor was completely removed in a concomitant open-heart surgery and laparotomy. Post operative course was uncomplicated. A month later the patient was feeling well and in good clinical condition. The histological analysis consisted with intravascular leiomyomatosis. Discussion Intracardiac leiomyomatosis is a rare clinical condition which requires high index of suspicion. Multimodality imaging is usually required to establish the preoperative diagnosis, although the final diagnosis is achieved with tissue investigation. Complete surgical resection of the tumor is curative and associated with good long-term prognosis.

Download Full-text

Surgical treatment of intravenous leiomyomatosis involving the right heart: a case series

Journal of International Medical Research ◽

10.1177/0300060519858021 ◽

2019 ◽

Vol 47 (7) ◽

pp. 3465-3474

Author(s):

Guangze Luo ◽

Hongrui Pan ◽

Jiaxue Bi ◽

Yudong Luo ◽

Jiechang Zhu ◽

...

Keyword(s):

Surgical Treatment ◽

Inferior Vena Cava ◽

Inferior Vena ◽

Vena Cava ◽

Case Series ◽

Iliac Vein ◽

Right Atrial ◽

Intravenous Leiomyomatosis ◽

Right Heart ◽

The Right

Objective This study was performed to investigate the surgical treatment of intravenous leiomyomatosis involving the right heart. Methods The clinical data of five patients with intracardiac leiomyomatosis treated from April 2002 to October 2017 at a single center were retrospectively analyzed. Results All five patients underwent successful intravenous and right atrial tumor removal via abdominal and inferior vena cava incisions. In three patients, these incisions were combined with thoracotomy and a right atrial incision, and in two patients, they were combined with uterine and bilateral fallopian tube and ovarian resection. One patient with advanced disease underwent a one-stage procedure and died thereafter. Of the remaining four patients who underwent follow-up for 1.5 to 12.0 years, one developed recurrence at 1 year postoperatively. The recurrent tumor, which was pathologically confirmed to be an intravenous leiomyoma, was removed via inferior vena cava and internal iliac vein incisions without subsequent recurrence. Conclusions The main treatment goal for inferior vena cava leiomyomas involving the right heart is to first address the severe obstruction of cardiac blood flow and then pursue second-stage surgery. Concurrent thoracotomy appears unnecessary because moderately sized right heart tumors can be gently removed via the inferior vena cava.

Download Full-text