Anesthetic Management of Successful Resection of Hepatocellular Carcinoma with Tumor Thrombus Extending into Right Atrium under Cardiopulmonary Bypass and Deep Hypothermic Circulatory Arrest without Median Sternotomy

Abstract

  A 66-year-old man presented with a hepatocellular carcinoma with a tumor thrombus extending into the right atrium and was scheduled for en bloc hepatectomy and resection of the thrombus under cardiopulmonary bypass (CPB). The patient had previously undergone a coronary artery bypass graft, and we were concerned that there was a risk of accidental dissection of mediastinal adhesions or the bypass graft itself. We therefore decided to operate under cardiopulmonary bypass and deep hypothermic circulatory arrest without redoing a midline median sternotomy. The surgery was successfully performed. Echocardiography was employed intraoperatively to monitor the movement of the tumor thrombus in the right atrium and position of the venous cannulae for the CPB and central venous catheter. The post-operative course was uneventful.