title: Cardiac arrest during radical nephrectomy due to a mass in the right ventricular outflow tract.
abstract: We report cardiac arrest due to obstruction of the right ventricular outflow tract (RVOT) caused by an RVOT mass that was not identified preoperatively. A 62-year-old woman with renal cell carcinoma (RCC) experienced deteriorating hypotension and bradycardia during radical nephrectomy. Hemodynamic stability was maintained on extracorporeal membrane oxygenation, and after surgery, she was transferred to the intensive care unit. On postoperative day 3, transthoracic echocardiography showed an intracardiac mass obstructing the RVOT, which caused severe functional pulmonary stenosis and moderate resting pulmonary hypertension. Despite maintaining extracorporeal membrane oxygenation, the patient died of cardiac arrest. Our findings suggest that it may be necessary to perform additional tests if RCC has invaded the renal vein and inferior vena cava or if a patient with RCC has abnormal cardiovascular symptoms without definite etiology for exclusion of cardiac metastasis or tumor thrombus. In addition, intraoperative transesophageal echocardiography might be the procedure of choice for the evaluation of these conditions because other diagnostic tests are difficult to perform during surgery. In conclusion, for patients with acute hemodynamic instability for whom other possible causes have been excluded, we recommend that anesthesiologists use transesophageal echocardiography to detect outflow tract obstruction or pulmonary thromboembolism and perform anesthetic management.
authors.affiliation: Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea.
authors.forename: Hee Young
authors.initials: HY
authors.lastname: Kim
authors.affiliation: Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea. Electronic address: md.baeksh@gmail.com.
authors.forename: Seung-Hoon
authors.initials: SH
authors.lastname: Baek
authors.affiliation: Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea.
authors.forename: Ji Uk
authors.initials: JU
authors.lastname: Yoon
authors.affiliation: Department of Urology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea.
authors.forename: Dong Hoon
authors.initials: DH
authors.lastname: Lee
authors.affiliation: Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea.
authors.forename: Gyeong-Jo
authors.initials: GJ
authors.lastname: Byeon
authors.affiliation: Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea.
authors.forename: Ji Hye
authors.initials: JH
authors.lastname: Ahn
mesh_terms: D002292:Carcinoma, Renal Cell / Q000601:surgery; D017548:Echocardiography, Transesophageal; D015199:Extracorporeal Membrane Oxygenation; D017809:Fatal Outcome; D005260:Female; D006323:Heart Arrest / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy*; D006338:Heart Neoplasms / Q000150:complications* / Q000000981:diagnostic imaging; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology* / Q000628:therapy*; D007680:Kidney Neoplasms / Q000601:surgery; D008875:Middle Aged; D009392:Nephrectomy; D018497:Ventricular Dysfunction, Right / Q000150:complications* / Q000000981:diagnostic imaging