Abstract PR063

Abstract

Background & Objectives: Inferior vena caval (IVC) tumor thrombus with cardiac extension is a very rare phenomenon, which proliferates fast and could be very challenging to the surgery. This research was designed to investigate the influence of Transesophageal Echocardiography (TEE) on the surgical resection of IVC tumor extending into right cardiac cavities. Materials & Methods: Six cases from our medical institute, preoperatively diagnosed as IVC tumor with cardiac extension and scheduled for the surgical resection, were retrospectively analyzed. In addition to real-time and dynamic monitoring, comprehensive TEE exams were performed for all the patients respectively after anesthesia induction, namely before tumor resection and after tumor resection. Cardiac extension was defined by the preoperative finding of cardiac mass originated from IVC tumor by Transthoracic Echocardiography (TTE), computerized tomography (CT) or CT angiography (CTA). Results: In all the cases, intraoperative TEE provided an accurate and excellent view of the IVC tumor. For case three, the IVC tumor was found at the IVC entrance to right atrium without further cardiac extension; for case five, the IVC tumor proliferated into right atrium but the extended cardiac mass was very slim and flexible and the tricuspid valve was untouched; for case four, the IVC tumor extended into right atrium and even cross the tricuspid valve but the extended cardiac mass was also very slim and flexible. Based on the TEE-provided information, the originally scheduled surgical decision was modified and the surgical resection was performed without cardiopulmonary bypass (CPB). For other three cases, the intraoperative TEE showed similar results to preoperative findings. The huge IVC tumor extended into the right heart, presented almost no flexibility and dramatically compromised the intracardiac blood flow. For the three cases, CPB support was indispensible for the tumor resection. The full TEE exam after tumor resection in all the six patients displayed clear surgical resection without tumor residuals, but in those three patients suffered with severely compromised cardiac extension, severe tricuspid regurgitation was noticed. All the six patients were closely monitored until discharged, and no TEE related complications were observed. Conclusion: Our research is the first report about TEE’s utilization in a series of consecutive patients undergoing surgical resection of IVC tumor with cardiac extension. In addition to its safety and effectiveness, TEE can provide valuable information for surgical decision making, results assessment of the surgical intervention and anesthesia management strategies. Disclosure of Interest: None declared