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Cavo-atrial thrombectomy prior to hepatectomy for hepatocellular carcinoma with tumor thrombus in the right atrium: a case report
- Source :
- Surgical Case Reports, Vol 5, Iss 1, Pp 1-7 (2019)
- Publication Year :
- 2019
-
Abstract
- Background Hepatocellular carcinoma (HCC) with tumor thrombus (TT) in the right atrium is a critical condition. The general consensus is to perform hepatectomy prior to cavo-atrial thrombectomy because of the risk of uncontrollable bleeding during the liver transection after heparinization. However, sudden cardiac arrest due to the ball-valve effect and pulmonary embolism have been reported in cases of TT. Cavo-atrial thrombectomy prior to hepatectomy for HCC with TT in the right atrium was successfully performed to prevent sudden cardiac arrest and pulmonary embolism. Case presentation Tumor thrombectomy under cardiopulmonary bypass with heparin and electrical ventricular fibrillation prior to hepatectomy was successfully performed to prevent sudden cardiac arrest or pulmonary embolism in a 75-year-old woman with a huge HCC and TT in the right atrium. After the neutralization of heparin, right hepatectomy with tumor thrombectomy in the inferior vena cava was performed. The total operation time was 9 h, and the total blood loss was 8200 mL. The patient’s postoperative course was uneventful, and she was discharged 14 days after surgery. One year after surgery, she is alive with HCC recurrence in the lung. Conclusions Cavo-atrial thrombectomy prior to hepatectomy for HCC with TT in the right atrium can be performed safely to prevent sudden cardiac arrest and pulmonary embolism by collaboration of cardiovascular surgeons and gastroenterological surgeons.
- Subjects :
- medicine.medical_specialty
Hepatocellular carcinoma
medicine.medical_treatment
lcsh:Surgery
Inferior vena cava
law.invention
03 medical and health sciences
0302 clinical medicine
law
Cardiopulmonary bypass
medicine
cardiovascular diseases
Thrombectomy
Right atrium
Lung
business.industry
Sudden cardiac arrest
lcsh:RD1-811
Heparin
medicine.disease
Tumor thrombus
Pulmonary embolism
Surgery
medicine.anatomical_structure
medicine.vein
030220 oncology & carcinogenesis
Ventricular fibrillation
cardiovascular system
030211 gastroenterology & hepatology
Hepatectomy
medicine.symptom
business
medicine.drug
Subjects
Details
- ISSN :
- 21987793
- Volume :
- 5
- Issue :
- 1
- Database :
- OpenAIRE
- Journal :
- Surgical case reports
- Accession number :
- edsair.doi.dedup.....543cb42527e63ef395a9e3da10158722