Video‐assisted thoracoscopic surgery in the treatment of non‐small‐cell lung cancer complicated with left atrial tumor thrombus

Abstract

We report a case of pulmonary squamous cell carcinoma complicated with a tumor thrombus in the left atrium. The left atrial tumor thrombus, together with the left lower lobe, was removed via complete video‐assisted thoracoscopic surgery (VATS), with cardiopulmonary bypass standby. The patient recovered well from surgery, received four cycles of postoperative chemotherapy, and is now under follow‐up at the outpatient clinic. Although the optimal treatment is still controversial, simultaneous VATS and atriotomy under the premise of preoperative evaluation of the thrombus, including size and extent, might prevent systemic embolization and sudden death, alleviate the wound, promote postoperative rehabilitation, and improve prognosis in selected patients.

Catheter related atrial thrombus caused by Abiotrophia defectiva: A case series and review of literature

“…4 Open surgical excision under cardiopulmonary bypass (CPB), minimally invasive thrombectomy without CPB, percutaneous intravascular removal of thrombus, AngioVac system for thrombus extraction, and video assisted thoracoscopic surgery are the surgical options available for CRAT which can be implemented as per the surgical expertise of the respective institutes. 4,9,10 To our knowledge, this is the first case series in which VATS has been successfully employed for removal of CRAT.…”

“…Video assisted thoracoscopic surgery (VATS) is a novel technique of atrial thrombus removal, associated with better post operative rehabilitation and prevention of sudden death due to systemic embolization compared to open surgical thrombectomy. 9 The choice of treatment for management of atrial thrombus inclusive of systemic anticoagulation, thrombolysis, or surgical thrombectomy is dictated by the hemodynamic status, clinical severity, thrombus size, and systemic embolization. 10 Systemic anti coagulation conjointly with removal of dialysis catheter can be attempted in CRAT size less than 6 cm.…”

“…4 The target INR should be maintained between 2 and 3 with treatment continuation for a period of 6 months along with dissolution of the thombi. 4,9,10 Thrombus size greater than 6 cm, contraindications for anticoagulation, associated endocarditis, structural heart defects, and unsuccessful thrombolysis of pulmonary embolism associated with CRAT are considered indications of surgical intervention. 4 Open surgical excision under cardiopulmonary bypass (CPB), minimally invasive thrombectomy without CPB, percutaneous intravascular removal of thrombus, AngioVac system for thrombus extraction, and video assisted thoracoscopic surgery are the surgical options available for CRAT which can be implemented as per the surgical expertise of the respective institutes.…”

Lung carcinoma extended to the left atrium through the right inferior pulmonary vein

“…The direct extension of left atrial tumor via pulmonary veins is uncommon ( 1 , 2 ). There are two types of cardiac invasion: direct invasion and expansion through a “limited” space (such as the pulmonary artery and vein) ( 3 ). Although tumors with direct cardiac extension are considered inoperable, complete resection may considerably prolong survival time for patients with tumors that only extend through the pulmonary veins and do not have pericardial and myocardial infiltration.…”