title: Echocardiography allows safer venous cannulation during excision of large right atrial masses.
abstract: BACKGROUND
  Excision of large right atrial masses requires bicaval cannulation and cardiopulmonary bypass. Safe venous cannulation can be accomplished only by knowing the exact intracavitary location and extension of the mass to avoid fragmentation. Transthoracic echocardiography and intraoperative transesophageal echocardiography, although helpful, cannot always define the exact intracavitary relationships of the tumor.
  
  
  METHODS
  We have used both intraoperative transesophageal and epicardial echocardiography to guide venous cannulation in 4 patients with large right atrial masses. Both echo images are used by the surgeon to select the exact site and method of cannulation to avoid fragmentation of the mass. Epicardial echocardiography complemented the images obtained by transesophageal echocardiography.
  
  
  RESULTS
  The technique of combined transesophageal and epicardial echocardiography allowed safe venous cannulation in all 4 patients. Each of the right atrial masses was safely excised using case-specific cannulation techniques guided by the echocardiographic images.
  
  
  CONCLUSIONS
  We propose the routine use of both intraoperative transesophageal and epicardial echocardiography in guiding venous cannulation for safe excision of large right atrial masses.
authors.affiliation: Division of Cardiac Surgery, Baystate Medical Center, Springfield, Massachusetts 01107, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Rousou
authors.forename: D A
authors.initials: DA
authors.lastname: Tighe
authors.forename: R D
authors.initials: RD
authors.lastname: Rifkin
authors.forename: R M
authors.initials: RM
authors.lastname: Engelman
authors.forename: J E
authors.initials: JE
authors.lastname: Flack
authors.forename: D W
authors.initials: DW
authors.lastname: Deaton
authors.forename: C A
authors.initials: CA
authors.lastname: Anene
authors.forename: E A
authors.initials: EA
authors.lastname: Fernandes
mesh_terms: D000328:Adult; D000368:Aged; D002405:Catheterization, Central Venous / Q000379:methods*; D004452:Echocardiography / Q000379:methods; D017548:Echocardiography, Transesophageal; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000601:surgery*; D006331:Heart Diseases / Q000000981:diagnostic imaging / Q000601:surgery; D006338:Heart Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000601:surgery; D014684:Venae Cavae / Q000000981:diagnostic imaging