Managing anesthesia during the surgical resection of extraskeletal Ewing's sarcoma of the azygous vein, the superior vena cava, and the right atrium

Abstract

　Extraskeletal Ewing's sarcoma rarely invades the cardio-vascular system. This report concerns a pediatric patient who underwent open-heart surgery for the resection of Ewing's sarcoma.

　An 8 year-old boy presented an Ewing's tumor in the posterior mediastinum, which had invaded the azygous vein, superior vena cava, and right atrium. After emergency spinal decompression, resection of the cardiac tumor was scheduled. Our anesthesia plans aimed to prevent tumor incarceration and embolisms. The possibility of right heart failure and conduction disturbance due to tumor invasion were also considered. After the patient was carefully transferred to the operating table, anesthesia was induced with intravenously. A percutaneous cardiopulmonary support device and an external pacemaker were prepared in case of an emergency. The tumor was observed closely by trans-esophageal echocardiography (TEE) and successfully removed while the patient was under cardiopulmonary bypass.

　This case demonstrated that successful resection of cardiac Ewing's tumor required gentle postural change, sufficient preparation of medical staff, sufficient blood for transfusion, a percutaneous cardiopulmonary support device and external pacemaker, close observation of the tumor by TEE, and the selection of an anesthesia method capable of maintaining stable cardiovascular dynamics.