Hemodynamic collapse under anesthesia in a patient with pulmonary artery sarcoma

Abstract

Purpose To describe a case of acute right ventricular dysfunction and hemodynamic collapse under general anesthesia in a patient undergoing resection of a pulmonary artery sarcoma. Clinical features A 67-yr-old woman with a presumptive diagnosis of pulmonary embolism presented to the hospital with progressive shortness of breath and syncope despite therapeutic anticoagulation. An echocardiogram revealed a large mass in the main pulmonary artery and a right ventricular systolic pressure of 105 mmHg. She was referred to our centre for urgent surgical management.

Anesthetic management of the removal of a giant metastatic cardiac liposarcoma occupying right ventricle and pulmonary artery

“…Another potential mechanism is the sudden dilatation of RV. Flexman AM et al reported with TEE monitoring that the distended RV in the condition of acute RV failure forced the interventricular septum to be shifted the left, which reduced the left ventricle volume further [12]. In our case, the surgeon did find the heart congestion during the exploration.…”

“…CVP is possible, but the catheter cannot be too close to superior vena cava-right atrium junction; Transesophageal ECG will be very helpful in multiple aspects: confirming diagnosis, assessment of the mass, evaluation of blood volume status, cardiac function and comorbidities, monitoring the evolving process of the surgical procedure. In addition, it is useful in detecting the tumor fragmentation, dislodgement or embolism [12,13]. Unfortunately we did not use TEE (transesophageal echocardiography) due to technical difficulties.…”

“…Surgical sterilizing and draping before the initiation of induction of anesthesia is also mandatory. In some report, some authors even suggested to prepare for femoral-femoral cannulation and bypass [12]. …”

Occlusion of the pulmonary artery by a primary pulmonary artery sarcoma resulting in cardiac arrest: a case report

“…Complete surgical resection can improve the prognosis [1], although few studies have reported on the surgical management for PPAS [2,3]. PPAS is associated with a risk of circulatory collapse in cases with increased central venous and right ventricular pressure [2]. We describe the case of a patient who went into cardiopulmonary arrest 90 min after anesthesia induction for complete resection of a PPAS.…”

“…Primary pulmonary artery sarcoma (PPAS) is a rare tumor that is associated with a poor prognosis. Complete surgical resection can improve the prognosis [1], although few studies have reported on the surgical management for PPAS [2,3]. PPAS is associated with a risk of circulatory collapse in cases with increased central venous and right ventricular pressure [2].…”