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THE JOURNAL OF CARDIOVASCULAR SURGERY

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The Journal of Cardiovascular Surgery 1998 October;39(5):641-7

Copyright © 2000 EDIZIONI MINERVA MEDICA

lingua: Inglese

Intraoperative management for removal of tumor thrombus in the inferior vena cava or the right atrium with multiplane transesophageal echocardiography

Koide Y., Mizoguchi T., Ishii K., Okunura F.

From the Department of Anesthesiology, Yokohama City University School of Medicine, Yokohama, Japan


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Back­ground. To inves­ti­gate the ­role and ­impact of mul­ti­plane tran­se­soph­a­geal ech­o­car­di­og­raphy ­during throm­bec­tomy in the infe­rior ­vena ­cava or the ­right ­atrium.
Experi­mental ­design. Ret­ro­spec­tive.
Set­ting. A uni­ver­sity hos­pital.
Par­tic­i­pants. ­Four ­patients who under­went ­removal of ­tumor ­thrombus in the infe­rior ­vena ­cava (IVC) or the ­right ­atrium.
Inter­ven­tions. The med­ical ­records of 4 ­patients and vid­eo­tapes of ­these intra­op­er­a­tive tran­se­soph­a­geal echo-­car­di­og­raphy exam­ina­tions ­were ­reviewed.
­Results. ­Before throm­bec­tomy, mul­ti­plane tran­se­soph­a­geal ech­o­car­di­og­raphy (­MTEE) pro­vided excel­lent IVC ­long ­axis ­view, ­which ­offered pre­cise rec­og­ni­tion of the ­cephalic ­extent of ­tumor, ­extent of ­caval occlu­sion, char­ac­ter­iza­tion of the ­tumor ­head. ­During sur­gery, ­MTEE ­could pro­vide con­tin­uous mon­i­toring of car­diac func­tion, car­diac ­volume, and pul­mo­nary embo­lism. More­over, ­MTEE ­could pro­vide the ­useful ­images of a can­nula or the ­caval occlu­sion bal­loon cath­eter, ­which facil­i­tated ­removal of neo­plasm ­extending ­into the IVC.
Con­clu­sions. We pre­sented ­four sur­gical ­cases, in ­which the ­removal of the ­tumor ­extended ­into the infe­rior ­vena ­cava or the ­right ­atrium ­using ­MTEE. ­MTEE ­could pro­vide val­u­able infor­ma­tion ­such as excel­lent ­images of the ­tumor, car­diac func­tion, the posi­tion of a can­nula or the ­caval occlu­sion bal­loon cath­eter. ­These find­ings ­could ­improve the anes­thetic man­age­ment of the ­patients, as ­well as the sur­gical ­approach and tech­nical maneu­vers, and facil­i­tate ­removal of neo­plasm ­into the IVC.

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