We conclude that the ITCP is higher in normothermic CPB than in hypothermic CPB; however, the clinical significance of this observation needs further investigation.

held in the IVC orifice. As the IVC was then occluded, Indications any embolic migration was prevented during removal of the kidneys. The right kidney was thus completely freed, Surgery for extensive cavoatrial extension of renal malignant tumours is a complex procedure [1] that is even being attached only by the renal vein. The portal vein and left renal vein were clamped. The IVC was incised more diÃcult to perform in the obese and elderly. A patient was admitted to our hospital with macroscopic in front of the right renal vein; this venotomy was extended for 5 cm downstream to gradually release the haematuria causing severe anaemia (haemoglobin 7.2 g/L, haematocrit 24%); the patient was a 78-yeartumour adhering to the first 3 cm of the IVC. The surgical specimen and thrombus could then be readily old woman, 1.63 m tall and weighing 78 kg. Ultrasonography of the abdomen detected a tumour of the upper pole of the right kidney with intracaval tumoral extension; the tumour measured 11×10×9 cm. Cavography (Fig. 1) revealed a mobile cavoatrial tumoral extension which appeared not to adhere to the inferior vena cava (IVC) in the retrohepatic area, particularly in the region of the suprahepatic veins. Transthoracic and transoesophageal cardiac ultrasonography revealed an extremely mobile, right, intra-atrial tumour impinging on the tricuspid valve in diastole. There was no evidence of metastases during the staging examination. The patient underwent surgery 5 days after admission. MethodThe incision combined a sternotomy with subcostal laparotomy on both sides. Two purse-string sutures were made in the right atrium, one for cannulation and the other to facilitate the introduction of a finger into the atrium (Fig. 2). The great vessels were exposed in the abdomen after displacing the hepatic flexure and the duodenum. The right renal artery was ligated. The sub-renal IVC, the left renal vein and the portal vein were then monitored.A veno-venous shunt (Biomedicus pump, France) was installed between the femoral vein and the atrium. The shunt was purged with heparinized saline (20 mg heparin) and the patient received 30 mg heparin. During surgery, a finger was introduced into the right atrium through the purse-string suture, the sub-renal IVC was clamped and the shunt made operational. The finger

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