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.