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Publish Date: 1991/12/01
Volume: 5, Issue: 12, Pages: 653-656
Abstract
Tumorrelated obstruction of the inferior vena cava extending into the right hearta plea for surgery in deep hypothermic circulatory arrest European Journal of CardioThoracic Surgery Volume 5 Issue 12 December 1991 Pages 653–656 https//doiorg/101016/101079409190122ZThis study reviews eight patients 3963 years old with tumorrelatedobstruction of the inferior vena cava IVC extending into the right atriumn = 5 and ventricle n = 3 Five patients suffered from renal cellcarcinoma 3 from sarcomatous disease The general approach was a mediansternotomy and laparotomy with hypothermic circulatory arrest 170205degrees C 2346 min in six patients while in two patients the IVC wasclamped sequentially under moderate hypothermia and extracorporealcirculation Four patients had tumor infiltration of the IVC necessitatingpartial caval resection In three the IVC was reconstructed by fabricpatches or tubular prothesis In one patient the continuity of the IVC wasinterrupted permanently Three patients underwent nephrectomy during thesame procedure two before and one after IVC disobliteration In onepatient each pulmonary embolectomy and intrahepatic IVC stenting wereperformed Two patients died early one due to uncontrollable hemorrhagethe other due to noncardiogenic pulmonary edema Six patients weredischarged in good physical condition and are still alive at a meanfollowup of 24 months Five patients have since remained free ofrecurrence one patient underwent three further surgical interventions forbone metastases We feel that IVC desobliteration is feasible in selectedcases with extended tumor related obstruction with an acceptable earlyrisk and late outcome
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