Anesthetic management of the removal of a giant metastatic cardiac liposarcoma occupying right ventricle and pulmonary artery

Abstract

A 60 years old chinese male scheduled for a removal of an intracardiac mass occupying majority of right ventricular space, right ventricular outflow tract and pulmonary artery. The giant cardiac mass was later diagnosed pathologically as metastatic liposarcoma. The patient had a history of surgical removal of myxoid liposarcoma from his left thigh many years ago. It is extremely rare for liposarcoma to metastatize to right ventricle and pulmonary artery. The anesthetic management of the surgical procedure to remove this kind of intracardiac mass poses significant challenges to anesthesia providers. Our patient developed refractory hypotension after induction of general anesthesia which necessitated urgent cardiopulmonary bypass. The surgical procedure was successful and the patient recovered from the surgery and was discharged home without significant complication. Accurate preoperative diagnosis and assessment of patient’s functional status, appropriate preoperative volume status, emergency cardiopulmonary bypass readiness, smooth and gentle induction of general anesthesia with less myocardial depressing agent, and closely monitoring patient’s vitals and hemodynamic parameters are imperative in managing this kind of patients.

Initiation of Cardiopulmonary Bypass in a High-Risk Patient Under Regional Anesthesia: A Case Report

“…Previous case reports involving intracardiac masses obstructing right-sided outflow document this hemodynamic instability after induction that then required urgent initiation of cardiopulmonary bypass (CPB). 3,4 The use of awake CPB is rare and reserved for patients at the highest risk for airway compromise or hemodynamic collapse on induction of anesthesia. [5][6][7][8] While this approach successfully avoids induction complications, the cannulation process causes anxiety and pain that may lead to unwanted hemodynamic changes in an already hemodynamically compromised patient.…”

Isolated Subcutaneous Metastasis of Myxoid Liposarcoma: A Case Report

“…Rare sites of metastatic disease spread include the skin, soft tissues, bone, liver, heart and brain [12,[16][17][18][19][20][21][22][23].…”

Successful resection of a huge metastatic liposarcoma in the pericardium resulting in improvement of diastolic heart failure: a case report

“…Although liposarcoma often metastasizes to different organs, cardiac metastasis, including to the pericardium, is rare. Thirty-five cases of metastatic cardiac liposarcoma have been reported in the literature [ 1 – 6 ], with only nine cases of pericardial metastases [ 2 – 4 ]. According to the WHO classification, liposarcoma is divided into the following categories: well-differentiated, differentiated, myxoid, round-cell, pleomorphic, mixed-type liposarcoma, and liposarcoma, not otherwise specified.…”