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Transesophageal echocardiography diagnosis of tricuspid obstruction by a vena cava tumour

Y. Blanloeil, MD^*, C. Le Roux, MD^*, J.C. Rigal, MD^*, Y. Le Teurnier, MD^* and P. Chaillou, MD

^* From the Service d'Anesthésie et de Réanimation Chirurgicale, Hôpital G et R Laënnec, CHU Nantes, 44093 Nantes, France and
Service de Chirurgie Vasculaire, Service d'Anesthésie et de Réanimation Chirurgicale, Hôpital G et R Laënnec, CHU Nantes, 44093 Nantes, France.

Address correspondence to: Dr. Y. Blanloeil, Service d'Anesthésie et de Réanimation Chirurgicale, Hôpital G et R Laënnec, Boulevard J Monod, CHU Nantes, 44093 Nantes, Cedex 01, France. Phone: 33-02-40-165304; Fax: 33-02-40-165294; E mail: yvonnick.blanloeil{at}chu-nantes.fr

Purpose: To present the anesthetic management for excision of a primary tumour of the inferior vena cava.

Clinical features: Resection of a primary tumour of the inferior vena cava without extension to the right atrium was scheduled without extra-corporeal circulation (ECC). The operation consisted of tumour excision with transtumoral clamping. During the immediate postoperative period, tricuspid obstruction was suspected when a "cannon a wave" was recorded from the right atrial pressure curve. Transesophageal echocardiography confirmed the diagnosis of tumour obstruction of the tricuspid valve.

Conclusion: Tricuspid obstruction due to postoperative mobilization of a primary tumour of the inferior vena cava was diagnosed by transesophageal echocardiography. Perioperative management particularities of the primary tumour of the vena cava are discussed.