RESUMO
Right atrial tumor thrombus is rare in patients with visceral malignant tumors and can cause right heart failure or sudden death. We present 2 cases of right atrial tumor thrombus treated under deep hypothermic intermittent circulatory arrest (DHICA). A 45-year-old man with right heart failure was diagnosed with right renal cancer extending to the right atrium. Computed tomography revealed no metastasis. He underwent right nephrectomy and tumor thrombus resection under DHICA. He was discharged on postoperative day 11 in good clinical course. A 67-year-old woman with hepatitis C virus liver cirrhosis( Child-Pugh A) was diagnosed with hepatocellular carcinoma and right atrial tumor. She underwent S8 and tumor thrombus resection under DHICA. Hemorrhagic diathesis was controlled using fresh frozen plasma transfusion. She was discharged on postoperative day 24 without liver failure. In cases of atrial tumor thrombus resection, DIHCA may be useful to achieve a bloodless operation field because the procedure is relatively simple and the primary disease need not be considered.
Assuntos
Carcinoma Hepatocelular/cirurgia , Carcinoma de Células Renais/cirurgia , Átrios do Coração/cirurgia , Neoplasias Cardíacas/cirurgia , Neoplasias Renais/cirurgia , Neoplasias Hepáticas/cirurgia , Trombose/cirurgia , Idoso , Carcinoma Hepatocelular/irrigação sanguínea , Carcinoma Hepatocelular/secundário , Carcinoma de Células Renais/irrigação sanguínea , Carcinoma de Células Renais/secundário , Parada Circulatória Induzida por Hipotermia Profunda , Evolução Fatal , Feminino , Neoplasias Cardíacas/irrigação sanguínea , Neoplasias Cardíacas/secundário , Humanos , Neoplasias Renais/irrigação sanguínea , Neoplasias Renais/patologia , Neoplasias Hepáticas/irrigação sanguínea , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , RecidivaRESUMO
Echocardiography of a 60 year-old woman with a three-year history of heart murmur revealed a coronary artery fistula. Coronary angiography indicated right coronary artery ectasia and fistula. The pulmonary-to-systemic blood flow ratio was 1.4, and left-to-right shunt, 29%. On follow-up, infective endocarditis of the tricuspid valve had developed and was treated using antibiotics. The right coronary artery was dilated along its length and was saccular at the distal aspect. At this point, a fistula also connected by the left anterior descending and left circumflex arteries drained into the right ventricle. Fistula closure and reduction aneurysmectomy were performed.
