Complete Intraoperative Transesophageal Echocardiogram Imaging of the Extent of an Inferior Vena Cava Mass Guides Surgical Management

Little, Sarah J.; Heusen, Frank Van der; Thornton, Kevin C.

doi:10.1213/ane.0b013e3181f1f919

Cited by 13 publications

(6 citation statements)

References 5 publications

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“…Moreover, intraoperative TEE imaging managed to reveal a thin sliver of residual tumor entangled in the tricuspid valve during rewarming phase and thereby modified the surgical management in another case. [18] In our study, 4 out of 36 patients adopted the surgical technique of direct tumor extraction from abdominal approach with complete avoidance of CPB and DHCA due to TEE monitoring. Additionally, another patient in our study was able to avoid cardiac arrest and experienced complete tumor extraction directly through the right atrium with the guidance of TEE.…”

Section: Discussionmentioning

confidence: 99%

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Perioperative management of intracardiac leiomyomatosis

Xu¹,

Wei²,

Miao

et al. 2017

Medicine

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Intracardiac leiomyomatosis (ICLM) is a rare condition in which the benign tumor extends into the right heart chambers through inferior vena cava. The best surgical approach still remains unclear.We present a retrospective cohort of 36 patients diagnosed with ICLM in Peking Union Medical College Hospital between 2002 and 2016.The mean patient age was 44.5 (range 25–55) years. The clinical manifestations were various, including shortness of breath, chest tightness, edema of the lower extremities, palpitations, syncope, etc. Cardiac function of 30 patients (80%) remained mildly influenced, classified as New York Heart Association (NYHA) I-II. After careful preoperative evaluation, 19 patients underwent 1-stage operation while the other 17 patients underwent 2-stage operations. The original surgical plans were changed in 5 patients (14%) due to intraoperative transesophageal echocardiography (TEE) monitoring, with the tumor directly extracted through abdominal approach or right atrium without cardiopulmonary bypass and/or deep hypothermic circulatory arrest. Complete resection was achieved in 32 patients (89%). Despite increased volume of blood loss (P < .05), patients undergoing 1-stage operation had significantly shorter operation time, anesthesia time as well as hospital length of stay (P < .05), compared with 2-stage operations. The postoperative complication rates were not different between the 2 groups (P = .684). During mean follow-up time of 36.1 months, recurrence occurred in 7 patients (23%) but all are survived.Precise and full-scale preoperative evaluation of both the tumor anatomy and the patient's tolerability to the surgery should be performed. TEE plays a crucial role in guidance of surgical decision making, and 1-stage extraction of tumor through either abdominal approach or right atrium may be possible.

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Section: Discussionmentioning

confidence: 99%

“…Therefore, we recommend that TEE imaging should be utilized in 3 phases of the surgery: before, during, and after resection. [18] …”

Section: Discussionmentioning

confidence: 99%

Perioperative management of intracardiac leiomyomatosis

Xu¹,

Wei²,

Miao

et al. 2017

Medicine

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“…Studies have found the diagnostic power of TOE impressive and comparable to spiral CT [2]. TOE is also useful at defining tumour extent and to aid the surgeons in ensuring complete tumour removal at the end of surgery [3]. Furthermore TOE-guided intraoperative assessment of volume status and cardiac function allows appropriate resuscitation leading to improved outcome in cases of massive blood loss, tumour embolisation or flow obstruction at the tricuspid valve.…”

Section: Discussionmentioning

confidence: 99%

Anaesthetic management for intra‐abdominal malignancies with cardiac involvement: A report of two cases and review of literature

et al. 2016

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As imaging and diagnostic capabilities improve, an increasing number of patients will present for complex surgical procedures requiring a multidisciplinary team approach. Atrial tumour thrombus secondary to intra-abdominal malignancy presents major challenges for both anaesthetic and surgical management. This often requires the use of both cardiopulmonary bypass and deep hypothermic circulatory arrest. We describe the anaesthetic management of two rare intra-bdominal sarcomas with cardiac involvement. Both patients underwent successful radical resection of sarcoma with inferior vena caval thrombectomy. We also review the available literature regarding the management of these patients.

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“…Trendelenburg position resulted in migration of the thrombus away from TV, resulting in some improvement in hemodynamics, and given enough time to go on emergency CPB. The importance of intra-operative TEE in such surgeries is clearly supported[ 1 6 8 9 10 11 12 13 14 15 ] in medical literature and apart from helping in diagnosing thrombus embolization, TEE also helps in performing a comprehensive evaluation of residual thrombus if present after surgery. [ 1 ]…”

Section: Discussionmentioning

confidence: 99%

Management of acute intra-operative thromboembolism in renal cell carcinoma

et al. 2015

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Renal cell carcinoma (RCC) is the most common malignant tumor of the kidney and has got association with inferior vena cava (IVC) extension in 5–10% of the patients. In this case report, we present a case of a 22-year- young female who was posted for radical nephrectomy and tumor thrombectomy to remove the thrombus extending up to IVC- right atrium junction. The surgical procedure was complicated by intraoperative thromboembolism during tumour manipulation. Continual Trans esophageal monitoring helps in early diagnosis of thromembolic event. Immediate diagnosis and awareness of clinical management in such circumstances contribute to a decrease in the associated morbidity and mortality.

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Complete Intraoperative Transesophageal Echocardiogram Imaging of the Extent of an Inferior Vena Cava Mass Guides Surgical Management

Cited by 13 publications

References 5 publications

Perioperative management of intracardiac leiomyomatosis

Perioperative management of intracardiac leiomyomatosis

Anaesthetic management for intra‐abdominal malignancies with cardiac involvement: A report of two cases and review of literature

Management of acute intra-operative thromboembolism in renal cell carcinoma

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