INTRAOPERATIVE MANAGEMENT FOR REMOVAL OF TUMOR THROMBUS IN THE INFERIOR VENA-CAVA OR THE RIGHT ATRIUM WITH MULTIPLANE TRANSESOPHAGEAL ECHOCARDIOGRAPHY

Background. To investigate the role and impact of multiplane transesop hageal echocardiography during thrombectomy in the inferior vena cava or the right atrium. Experimental design. Retrospective. Setting. A un iversity hospital. Participants. Four patients who underwent removal o f tumor thrombus in the inferior vena cava (IVC) or the right atrium. Interventions. The medical records of 4 patients and videotapes of the se intraoperative transesophageal echocardiography examinations were r eviewed. Results. Before thrombectomy, multiplane transesophageal echo cardiography (MTEE) provided excellent IVC long axis view, which offer ed precise recognition of the cephalic extent of tumor, extent of cava l occlusion, characterization of the tumor head. During surgery, MTEE could provide continuous monitoring of cardiac function, cardiac volum e, and pulmonary embolism. Moreover, MTEE could provide the useful ima ges of a cannula or the caval occlusion balloon catheter, which facili tated removal of neoplasm extending into the IVC. Conclusions. We pres ented 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, c ardiac function, the position of a cannula or the caval occlusion ball oon catheter. These findings could improve the anesthetic management o f the patients, as well as the surgical approach and technical maneuve rs, and facilitate removal of neoplasm into the IVC.