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Anaesthetic Management of Patient with Extensive Venous Sided Metastasis for Partial Gastrectomy and Excision of Metastatic Growth under Cardiopulmonary Bypass

Soniya Sulhyan, Anand Vagrali, Sharangouda Patil, Praveen Kalligudd, Mohan Gan, and Mahadev Dixit
KLE Heart Foundation, KLE¡¯s Jawaharlal Nehru Medical College and KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Krishna floor, Near ITU, Nehrunagar, Belgaum- 590010. Karnataka. India.
Abstract—Background: Primary cardiac tumors are very rare. Secondary cardiac tumours occur more commonly than the primary ones. Most frequent secondary cardiac tumors include Carcinoma lung and breast, melanomas, leukemias and lymphomas. Gastric leiomyosarcoma is rare. Gastric leiomyosarcoma metastasizes usually to the liver and surrounding structures. Leiomyosarcoma of the stomach rarely metastases to the heart. Methods: We describe anaesthetic management of a rare case of secondary right atrial leiomyosarcoma originating from stomach in a male patient aged 36 years with extension to Inferior Vena Cava (IVC), left lobe of the liver and embolism to Left Pulmonary Artery (LPA). He was scheduled for clearance of secondary extension from Right Atrium (RA), IVC and pulmonary artery with partial gastrectomy. The anaesthetic plan was general anaesthesia with controlled mechanical ventilation with invasive monitoring. Partial gastrectomy and partial resection of left lobe of liver was done through a midline laparotomy followed by median sternotomy for excision of the right atrial mass and embolectomy of left pulmonary artery under cardiopulmonary bypass (CPB) with Deep Hypothermic Circulatory Arrest (DHCA) using femoral venous cannulation for venous drainage. Results and Conclusion: Issues related to (1) Fixed cardiac output state during induction; (2) Embolization of tumor mass; (3) Central venous pressure line placement precautions; (4) Problems related to low IVC drainage after cannula placement; (5) Extensive nature of surgery with bleeding and hemostasis; (6) Postoperative respiratory dysfunction; and (7) Emphasis on usefulness of Transoesophageal Echocardiography during the perioperative period are discussed.

Index Terms—Gastric leiomyosarcoma, Secondary right atrial leiomyosarcoma, Pulmonary embolectomy, Deep Hypothermic Circulatory Arrest

Cite: Soniya Sulhyan, Anand Vagrali, Sharangouda Patil, Praveen Kalligudd, Mohan Gan, and Mahadev Dixit, "Anaesthetic Management of Patient with Extensive Venous Sided Metastasis for Partial Gastrectomy and Excision of Metastatic Growth under Cardiopulmonary Bypass," International Journal of Pharma Medicine and Biological Sciences, Vol. 2, No. 4, pp. 15-20, October 2013.
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