Anesthetic management of the removal of a giant metastatic cardiac liposarcoma occupying right ventricle and pulmonary artery.

A 60 years old chinese male scheduled for a removal of an intracardiac mass occupying majority of right ventricular space, right ventricular outflow tract and pulmonary artery. The giant cardiac mass was later diagnosed pathologically as metastatic liposarcoma. The patient had a history of surgical removal of myxoid liposarcoma from his left thigh many years ago. It is extremely rare for liposarcoma to metastatize to right ventricle and pulmonary artery. The anesthetic management of the surgical procedure to remove this kind of intracardiac mass poses significant challenges to anesthesia providers. Our patient developed refractory hypotension after induction of general anesthesia which necessitated urgent cardiopulmonary bypass. The surgical procedure was successful and the patient recovered from the surgery and was discharged home without significant complication. Accurate preoperative diagnosis and assessment of patient's functional status, appropriate preoperative volume status, emergency cardiopulmonary bypass readiness, smooth and gentle induction of general anesthesia with less myocardial depressing agent, and closely monitoring patient's vitals and hemodynamic parameters are imperative in managing this kind of patients.

The hemodynamic effect of total liquid ventilation in piglets with reduced cardiac function after cardiopulmonary bypass.

Total liquid ventilation (TLV) is a promising treatment for severe lung injury and heart resuscitation. We aim to investigate the hemodynamic effect of TLV in piglets with preexisting cardiac dysfunction. After onset of cardiopulmonary dysfunction induced by cardiopulmonary bypass (CPB), piglets were randomly treated with TLV (n = 6) or conventional gas ventilation (n = 6) for 240 min. Hemodynamics was monitored before and at a 30-min interval after CPB. CPB with cardiac arrest resulted in significant decrease in cardiac index (CI) (96.19 ± 6.74 vs. 48.58 ± 3.96 mL/min/kg, P < 0.001) and increase of pulmonary vascular resistance (PVR) (1123.38 ± 198.97 vs. 8180.62 ± 1041.35 dyne·s/cm(5), P < 0.001). Compared with conventional gas ventilation, there was no further significant decrease of CI or increase of PVR during TLV throughout the experiment. No significant difference was observed on other hemodynamic variables including heart rate, mean arterial pressure, mean pulmonary arterial pressure, and central venous pressure between both groups. The fluctuation of mean arterial blood pressure was 3.95 ± 1.68 mm Hg during TLV. No evidence of fluorothorax or cardiac tamponade was observed in either group. We conclude that TLV does not further impair hemodynamics in piglets with preexisting cardiac dysfunction immediately after CPB.

Severe mitral valve insufficiency after transcatheter atrial septal defect closure with the amplatzer septal occluder: a device-related complication.

Atrial septal defect (ASD) is the one of the most common congenital cardiac diseases. Percutaneous device closure of the ASD has developed as an alternative to traditional surgical closure with a similar outcome, decreased surgical trauma, and shorter hospital stay. However, several complications have been reported. We now report a rare complication of late severe mitral insufficiency (MI) after a successful closure of a secundum ASD with an Amplatzer device. The potential mechanisms may be the continual traction of the oversized mismatched device on the root of the mitral annulus and the insufficient rim to the mitral annulus. The patient was sent for a surgical operation to remove the device, and the defect was closed. No MI was found at the one-year follow-up.