tailieunhanh - Báo cáo y học: "Right ventricular exclusion for hepatocellular carcinoma metastatic to the heart"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Wertheim cung cấp cho các bạn kiến thức về ngành y đề tài: Right ventricular exclusion for hepatocellular carcinoma metastatic to the heart. | Liu et al. Journal of Cardiothoracic Surgery 2010 5 95 http content 5 1 95 JOTS JOURNAL OF CARDIOTHORACIC SURGERY CASE REPORT Open Access Right ventricular exclusion for hepatocellular carcinoma metastatic to the heart Wan-Chi Liu1 Kar-Wei Lui2 Ming-Chi Ho3 Shou-Zen Fan1 Anne Chao1 Abstract We used for the first time a right ventricular exclusion procedure for the treatment of hepatocellular carcinoma metastatic to the right ventricle. Our case report shows that this surgical option can be effective as rescue therapy for right ventricular outflow tract obstruction secondary to myocardial metastasis in critically ill patients. Most notably this technique can prevent inadvertent dislodgement of tumor cells. Background Right ventricular outflow tract obstruction secondary to myocardial metastasis from hepatocellular carcinoma HCC represents a rare event and portends a poor prognosis 1-4 . The clinical picture is chiefly dominated by severe cardiorespiratory compromise that may lead to cardiac arrest. Surgical resection with therapeutic intent is not an option for the majority of patients with metastatic involvement of the heart. However symptom relief after palliative surgery can improve quality of life. We hereby present a clinical case of intraventricular cardiac metastasis from HCC leading to right ventricular outflow tract obstruction. We used for the first time a right ventricular exclusion procedure as rescue therapy to relieve mechanical obstruction to blood flow and avoid life-threatening hemodynamic instability. In addition this procedure can prevent inadvertent dislodge-ment of tumor cells. Case Presentation A 46-year-old female patient complained of general weakness and increasing dyspnea for 1 month. She had been diagnosed 14 months earlier with a hepatocellular carcinoma for which she underwent extended right hepatectomy. After surgery the patient was treated twice with transarterial chemoembolization for small recurrent HCC