Anesthetic Management for Resection of Bilateral Pulmonary Artery Sarcoma

Abstract

We describe a patient who presented with a bilateral pulmonary artery sarcoma, initially treated as pulmonary embolism, that necessitated concomitant pulmonary endarterectomy and pneumonectomy. We reviewed the anesthetic management used for this procedure, which bears many similarities to the management of patients undergoing pulmonary thromboendarterectomy. Right ventricular failure, pulmonary hemorrhage, and cerebral ischemia due to circulatory arrest are life-threatening perioperative complications. The anesthesiologist can play a key role in the prevention (or timely recognition and treatment) of these perioperative complications by establishing adequate hemodynamic, echocardiographic, and neurologic monitoring and by optimizing cardiopulmonary function and coagulation.

Occlusion of the pulmonary artery by a primary pulmonary artery sarcoma resulting in cardiac arrest: a case report

“…In our case, because of circulatory collapse after induction of general anesthesia, emergent median sternotomy was necessary to start ECC. In contrast, in the PPAS case report published by Hoogma et al [3], an increase in CVP or findings of right heart overload was not identified, and there was no mention of deterioration in circulation dynamics after induction of anesthesia.…”

“…For bilateral PPAS, it is necessary to perform a pulmonary artery endarterectomy. This procedure requires deep hypothermia and circulation arrest to prevent backflow from bronchial arteries into the pulmonary artery [3]. For unilateral PPAS, diagnosed early, Fig.…”

“…Anesthesia management for PPAS surgery is challenging. In our PubMed search, using "pulmonary artery sarcoma" and "anesthesia" as keywords, we identified only two case reports describing anesthesia management for PPAS surgery [2,3]. Clear guidelines have yet to be established.…”

“…Primary pulmonary artery sarcoma (PPAS) is a rare tumor that is associated with a poor prognosis. Complete surgical resection can improve the prognosis [1], although few studies have reported on the surgical management for PPAS [2,3]. PPAS is associated with a risk of circulatory collapse in cases with increased central venous and right ventricular pressure [2].…”

Pulmonary artery sarcoma or chronic pulmonary thromboembolism – A diagnostic dilemma and an anaesthetic challenge

“…TCA prevented backflow of blood via the bronchial arteries and thus gave better bloodless surgical field. [ 3 ] The PA catheter was placed in the PA by the surgeon so as not to injure the bare intima. It was possible to wean the patient off CPB on moderate inotropic support.…”