Résumé
Objective:To investigate the feasibility and efficacy of combined general and cardiac surgery in the treatment of pediatric tumors with supradiaphragmatic inferior vena cava (IVC) and right atrium (RA) tumor thrombus.Methods:Retrospective analysis was performed on the clinical treatment of 8 pediatric tumor patients with supradiaphragmatic IVC and RA tumor thrombus treated by combined general and cardiac surgery in Children′s Hospital, Capital Institute of Pediatrics from June 2015 to May 2019.The operation was performed through a combined thoracoabdominal median incision.Cardiac surgeon opened the pericardium for cardiopulmonary bypass (CPB). Subsequently, general surgeon resected the primary abdominal tumor, cut open the subphrenic IVC, removed the subphrenic tumor thrombus, and made an attempt to remove the supradiaphragmatic tumor thrombus through the same incision of IVC.If the tumor thrombus cannot be completely removed through this incision, cardiac surgeon shall tighten the prefabricated pulmonary artery blocking band, establish CPB, and remove the supradiaphragmatic tumor thrombus in IVC or open RA to remove the atrial tumor thrombus.Results:In the 8 cases, there was hepatoblastoma in 4 cases, nephroblastoma in 3 cases, and adrenocortical carcinoma in 1 case.Among them, there was RA tumor thrombus in 4 cases, which was removed by right atrial thrombectomy under CPB; tumor thrombus in supradiaphragmatic IVC in 1 case, which was removed under CPB; subphrenic IVC in 3 cases, which was completely removed without the adoption of CPB.Among those 8 cases, 7 cases had complete resection of the tumor thrombus and 1 case had residual iliac vein tumor thrombus, and none of them developed pulmonary embolism.All the 8 cases underwent regular postoperative chemotherapy, and median follow-up time was 22.5 months (10-57 months), with 6 survived cases, 1 case died, and 1 case losing follow-up.Conclusions:Combined general and cardiac surgery can allow complete resection of the primary tumor and supradiaphragmatic and right a trial tumor thrombus in a single operation with reduced pain in patients, which could not only improve the rate of complete tumor resection but also reduce the risk of pulmonary embolism, thereby making the previously painful and risky surgery safer, more effective and more humane.
Résumé
Rhabdomyoma is the most common cardiac tumor in infancy and commonly located in the ventricles causing outflow obstruction or arrhythmias. We report a rare pediatric (7 month old) case of a right atrial rhabdomyoma presenting with severe cyanosis and low cardiac output from significant tricuspid inflow obstruction with right to left shunt across a stretched patent foramen ovale. We present an emergency cardiac surgery for right atrial tumor resection, and the management of separating the patient with failing right ventricle from cardiopulmonary bypass using a Glenn shunt, since extracorporeal membrane oxygenation (ECMO) or nitric oxide was not available.
Résumé
We report a rare case of primary cardiac angiosarcoma in the right atrium. A 47-year-old man was admitted to our hospital with cardiac tamponade. Echocardiography and computed tomography revealed a tumor in the right atrial cavity. We performed tumor resection to confirm the histological diagnosis, to prevent tumor embolism, and to increase the possibility of improving the prognosis. The tumor was resected with the right atrial wall and right pericardium. The right atrium was then reconstructed with a bovine pericardial patch. The pathological diagnosis was angiosarcoma. The patient survived only about 6 months after surgical resection, but there was no local recurrence. This report presents a very rare case of cardiac angiosarcoma associated with cardiac tamponade.