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J Thorac Cardiovasc Surg 2009;137:775-777
© 2009 The American Association for Thoracic Surgery

Brief Communication

Palliative bidirectional Glenn anastomosis for unresectable metastasis in the right ventricle from renal cell carcinoma 16 years after nephrectomy

Naoto Morimoto, MD*, Keisuke Morimoto, MD, Yoshihisa Morimoto, MD, Toshihito Sakamoto, MD, Akiko Tanaka, MD, Masamichi Matsumori, MD, Kenji Okada, MD, Yutaka Okita, MD

Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine, Kobe, Japan

Received for publication December 18, 2007; accepted for publication December 24, 2007.

* Address for reprints: Naoto Morimoto, MD, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Japan. (Email: naotom@med.kobe-u.ac.jp).

The first 20% of the full text of this article appears below.

We report a patient with late renal cell carcinoma metastasis to the right ventricle 17 years after radical nephrectomy. The unresectable huge metastasis caused hemodynamic impairment due to right ventricular inflow and outflow tract obstruction, which was managed by means of partial excision of right ventricular intracavity tumor, tricuspid valve replacement, and bidirectional cavopulmonary anastomosis.

Clinical Summary

A 53-year-old woman was admitted in a local hospital because of right-heart failure, including 2-month-old palpitation and dyspnea on exertion. Seventeen years earlier, she had undergone right nephrectomy for a high-grade (G3) clear cell–type renal cell carcinoma (RCC) (pT1 bN0 M0). Echocardiography showed that the massive right ventricular intracavity mass obliterated the right ventricular cavity. Pericardial effusion was massive and drawn off by pericardiocentesis. The diagnosis of metastatic RCC was made from biopsy. The patient was referred to us for further investigations and treatment.

Echocardiography and magnetic resonance imaging revealed a large mass that nearly obliterated the right ventricular cavity and that invaded into the ventricular septum. The . . . [Full Text of this Article]






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