Intraoperative Cardiogenic Shock Caused by Intracardiac Tumor Thrombi Obstruction

A 60-year-old man presented with left flank pain, a palpable abdominal mass, and hematuria for months. Computed tomography revealed a large tumor in the left kidney (approximately 17.7 cm in diameter) with evidence of left adrenal, left renal vein, and inferior vena cava (IVC) invasion. He underwent left nephrectomy with IVC thrombectomy. Transesophageal echocardiography (TEE) was used during the whole procedure and the tumor was found in the IVC (Fig-1) before resection. After resection of the main tumor, pulseless electrical activity (PEA) following the sudden onset of hypotension was noticed during the snaring of the IVC. Cardiopulmonary resuscitation was performed and emergent cardiopulmonary bypass (CPB) was established. Newly discovered thrombi appeared in the right atrium (Fig-2), right ventricle, main pulmonary artery, and descending aorta; consequently, these were resected to remove the thrombi.