Tumors of the right atrium and the inferior vena cava operated in deep hypothermic circulatory arrest

Abstract

Introduction: Tumors which most frequently metastasize to the heart include: malignant melanoma, lung cancer, breast cancer, ovarian cancer, kidney cancer, leukemia, lymphomas and esophageal cancer. Purpose: The purpose of this paper was clinical analysis of a group of patients operated in deep hypothermic circulatory arrest due to tumors of the right atrium and the inferior vena cava. Material and method: The study covered 7 patients operated at the Cardiac Surgery Clinic with a cardiac tumor diagnosed on the basis of an echocardiographic assessment in the years 2012–2019. Before qualifying for surgical treatment, each patient underwent: thorough interview and physical examination, 12-lead ECG, laboratory tests and echocardiography. Patients additionally underwent: computed tomography of the chest or abdomen, magnetic resonance imaging and coronary angiography on the basis of which patients with significant coronary artery changes underwent simultaneous coronary artery bypass graft. After preparation, the tumor was excised from the vena cava and right atrium with simultaneous removal of the primary tumor, most often kidney cancer. Early and distant results of treatment were analyzed in the examined group of patients to determine the following endpoints: hospital mortality and survival after surgery: after 3 months and 12 months. Results: Of all operated patients: 2 individuals died in the early postoperative period due to hemorrhagic complications (hospital mortality - 28.6%), and 5 patients (71.4%) were discharged from the Clinic in a good general condition. In total, 3-month survival was 71.4%, and 12-month survival amounted to 28.6%. Conclusions: Surgeries are very complex and challenging, and usually take on average 8-10 hours. It can improve the outcomes of palliative oncological treatment, better physical function (cardiovascular fitness) and extend life from several months to several years in more than 2/3 patients.

Cardiac Metastatic Tumors

“…However, the study held by Pietrzyk and colleagues was based on renal resection followed by removal of heart metastases from the right atrium and inferior vena cava—either as combined treatment or 2 separated surgeries. In their study, the 3-month survival was 71.4%, and 12-month survival—28.6% 17…”

“…In their study, the 3-month survival was 71.4%, and 12month survival-28.6%. 17 According to literature, the 5-year survival in metastatic disease is estimated as 26%. 13…”

“…4 Cardiac tumors may not cause any manifestations and may be revealed by accident when performing radiologic diagnostics for other reasons, during surgery or autopsy, but among potential manifestations, 1 can find the states listed in Table 2. 1,5,6,9,13,15,17 The symptoms mostly regard the cardiovascular system, but there is a rare case reported on neuroendocrine heart-located tumor, in which the manifestation was diarrhea. 11 Less frequent manifestations may also include Raynaud phenomenon, thrombocytopenia, cyanosis, or clubbing.…”