Materials and Methods
Resection of the cavoatrial tumor with thrombectomy was performed. CPB was established with ascending aortic cannulation and venous drainage from the right femoral vein with a 21-Fr long cannula and the superior vena cava. The tip of the femoral vein cannula was carefully adjusted in the proximal part of the IVC with a transesophageal echo guide to avoid contact with the tumor or thrombus. After CPB was established successfully, cardiac arrest with ascending aortic cross-clamping was induced by antegrade cardioplegia. The superior vena cava was snugged, and a right atriotomy was made. A yellowish granular tumor mass was observed in the RA extending distally into the IVC beyond the hepatic vein junction. It was difficult to remove the tumor completely in the bloody surgical field. Hence, with the IVC gently snugged, core cooling was initiated along with simultaneous surface head cooling with ice bags until targeted tympanic temperature of 25°C was achieved. HCA was then induced and the tumor was removed smoothly. Endoscopy was used to ensure complete resection of the tumor. The duration of HCA was 3 min. The patient was smoothly weaned from CPB using a low dose of catecholamine. The time of aortic cross-clamp, CPB, and surgery was 84, 172, and 304 min, respectively.