A Case of Advanced Esophageal Cancer with Pulmonary Hypertention due to Atrial Septal Defect

Abstract

A 62-year-old man was detected to have advanced esophageal cancer with pulmonary hypertension (PH) due to atrial septal defect (ASD). We planned to perform radical repair of ASD and neoadjuvant chemotherapy before esophagectomy. However, he went into shock with melena by using an anticoagulant before cardiac catheterization. Endoscopic examination showed hemorrhage from the esophageal tumor, which suggested that ASD repair should be preceded by esophagectomy to remove the hemorrhage source. After esophagectomy, circulatory dynamics was unstable. Pulmonary arterial pressure (PAP) temporarily exceeded arterial pressure (AP) with coughing on the second day after the operation. Strict management with infusion and administration of vasopressin led to stable circulatory dynamics. However, unstable dynamics seemed to recur and we decided to repair ASD. Amplatzer Septal Occluder was inserted with intra cardiac echocardiography (ICE) because trans-esophageal echocardiography could not be used. After amplazter insertion, he became in good condition and was transferred to POD another hospital on 20.