Renal cell tumors with thrombi in the right
atrium require immediate surgical treatment.
However, there is no consensus regarding the
surgical technique of choice.[
1-
7] The major critical
factor is successful surgery, mainly managing the
interior vena cava. The main goals are to minimize
bleeding and prevent embolism from the thrombus
during surgery.[
4] In addition, CPB may be required
in patients with a bulky, intraatrial thrombus.[
8]
However, those with a minimal and non-adherent
atrial thrombus may not require CPB.[
9] The choice
of a circulatory support technique consisting of either
normothermic perfusion with venous drainage or
total circulatory arrest with profound hypothermia
has not been defined yet. The main variables to
be considered in choosing the most appropriate
method are the surgeon's personal preference and
experience. An increased CPB time and the use of
deep hypothermia in circulatory arrest may result
in a several well-known complications such as
hemorrhage, neurological dysfunction, and organ
failures. Similarly, our patient had a 99% LAD
stenosis. In the light of the literature data, we
performed simultaneous nephrectomy, intracaval
and right atrial tumor excision, caval patchplasty
and CABG under normothermic CPB without cross
clamping or cardioplegic arrest.[
7]
To the best of our knowledge, this is the first case
reported in the literature in whom all the operations
were performed simultaneously.
Declaration of conflicting interests
The authors declared no conflicts of interest with
respect to the authorship and/or publication of this
article.
Funding
The authors received no financial support for the
research and/or authorship of this article.