A Case of Intraventricular Thrombosis and Heart Failure During Bevacizumab-Combined Chemotherapy for Primary Peritoneal Cancer

Abstract

Synopsis: We report a case of intraventricular thrombus and heart failure that occurred during bevacizumab-combined chemotherapy. The patient was a 55-year-old woman (gravida 3, para 3). Magnetic resonance imaging and ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (CT) scans suggested peritoneal dissemination and metastasis to the left parasternal lymph nodes. Diagnostic laparoscopy was performed, and a peritoneal biopsy confirmed high-grade serous carcinoma. The diagnosis was stage IIIC, cT3cNxM0 primary peritoneal carcinoma. Four cycles of preoperative bevacizumab-combined chemotherapy were administered, achieving a partial response (PR). Interval debulking surgery achieved complete resection of the tumor. Postoperatively, a 33×8 mm shadow defect was noted in the right ventricle on CT at day 44 of maintenance chemotherapy and was diagnosed as an intraventricular thrombus. Reduced ejection fraction (G4), left ventricular systolic dysfunction (G3), and right ventricular dysfunction (G3) were observed. The patient was hospitalized, and anticoagulation therapy and treatment for heart failure were initiated. On day 42 after the initiation of treatment, echocardiography showed resolution of the intracardiac thrombus and improvement of ejection fraction to 30%. The development of an intracardiac thrombus following bevacizumab administration is extremely rare. Given that deterioration in general condition may preclude continued chemotherapy, prompt diagnosis and initiation of treatment are desirable.