Supplementary Material for: Surgical Treatment of Hepatocellular Carcinoma with a Tumor Thrombus Invading the Right Atrium: A Case Report
Laura VeinbergaKristiāns MeidropsRoberts RumbaMārcis GediņšDeniss AnufrijevsJ. VilmanisKarina DrizlionokaEdgars ZellānsInguna KrustiņaJ. BērziņšIeva BriedeArmands SīviņšMaija RadziņaPēteris StradiņšArtūrs Ozoliņš
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Abstract:
Up to 3% of all HCC present with a tumor thrombus (TT) in the inferior vena cava (IVC) and right atrium (RA). Extensive growth of HCC into the IVC and the RA is associated with a particularly poor prognosis. This clinical condition is related to a high risk of sudden death due to pulmonary embolism or acute heart failure. Therefore, a technically challenging treatment undergoing hepatectomy and cavo-atrial thrombectomy is necessary. We report a 61-year-old man presenting with right subcostal pain, progressive weakness and periodic shortness of breath for 3 months. He was diagnosed with advanced HCC with a tumor thrombus (TT) extending from the right hepatic vein into the inferior vena cava (IVC) and right atrium (RA). A multidisciplinary meeting with cardiovascular and hepatobiliary surgeons, oncologists, cardiologists, anesthesiologists and radiologists was held to determine the best treatment approach. Initially, the patient underwent right hemihepatectomy. As follows, the cardiovascular stage using cardiopulmonary bypass was successfully performed, removing the TT from the RA and ICV. In the early postoperative period the patient remained stable and was discharged on the 8th postoperative day. A morphological examination revealed Grade 2/3 HCC, a clear cell variant with the microvascular and macrovascular invasion. Immunohistochemical staining was positive for HEP-1, CD10, whereas negative for S100. The morphological and immunohistochemical results corresponded to HCC. The treatment of such patients requires the cooperation of various specialties. Although, the approach of the surgery is extremely complex including specific technical support, as well as high perioperative risks, the result offers favorable clinical outcomes.Keywords:
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Right heart thrombus is rare in structurally normal heart. Here, we report a 74-year-old man with a right atrial thrombus who presented with shortness of breath.
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The right atrium has three functions:reservoir,conduit and pump.In this article we are going to review the different changes in the right atrium in different kinds of cardiac disease.We will also summarize some indexes and methodology used in the study of the right atrium.
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Objective: In order to study ultrastructure of right atrium in SHR. Methods: The transmission electron microscopy was used to study the ultrastructure of the cardiac myocytes in right atrium. Results: The results showed that focal disarray of myofibrils and the mitochondria were proliferated during early hypertension and the apoptotic cells and the bodies were observed in SHR. Conclusion: Although right atrium was non-stressed during early hypertension, it would be influenced inevitably and come forth morphological,structural changes.
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Pulmonary veins (PVs) usually drain into the left atrium (LA) and are frequently targeted for electrical isolation, since it became evident that PVs may trigger and maintain paroxysmal atrial fibrillation (AF). We present a patient with right‐sided PVs anomalously connecting to the right atrium with lack of electrical PV‐atrial connection. Therefore, isolation of the left veins was performed resulting in freedom from AF as shown during a midterm follow‐up. These findings indicate that PV connection to the LA may be a prerequisite for the arrhythmogenic properties of the PVs causing AF. (PACE 2010; 1–4)
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Single atrium or common atrium is a rare, isolated defect. We report here an adult patient with single atrium detected by transthoracic echocardiography.
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