[HSF] Renal cell ca

[A]

Jay:
Interesting approach as we have an aggressive group of urologists we may be
called to one of these. My question where do you put venous line? Do you
only use the SVC and go bypass on one venous canula? Please clarify
Thanks

Ahmed




On 5/31/07, Jacob Lavee, MD <jaylavee at netvision.net.il> wrote:
>
> Ed,
> I've done 6 such cases together with our urologists and they were all
> successful. In all cases we've gone on pump following initial abdominal
> preparation by the urologists and cooled the patients down to deep
> hypothermia. Once total circulatory arrest is initiated we've worked in
> parallel - me opening the RA and evacuating the tumor tissue from the RV,
RA
> and down the IVC as far as I could get from inside the RA, while they
opened
> the abdominal IVC and took out the rest of the tumor from below, until
both
> our fingers could meet each others from inside the IVC. The rest of the
> operation is straight forward being completed by nephrectomy. In all these
> cases the urologists blessed me for providing them a clean and bloodless
> environment to clean the entire IVC and sometimes even into the iliacs.
>
> Jay Lavee
>
> From: Edward Bender
> To: OpenHeart-L
> Sent: Thursday, May 31, 2007 5:50 AM
> Subject: [HSF] Renal cell ca
>
>
> Here's tomorrow's interesting case.  60 year old insulin dependent
> diabetic hypertensive smoking female with hematuria.  She has a right
> renal cell carcinoma with tumor thrombus.  I had her cathed and she
> has normal coronaries.  Below are the relatively suboptimal CT scans
> and echo.  I've never had to go on bypass to resect one of these, but
> this one may be different.  There is extensive thrombus extending
> into the RV through the tricuspid valve.  There is retrograde
> thrombus into the left renal vein and the distal IVC and iliac vein.
> I plan on trying to pull this down from below, but will be ready to
> go on bypass if needed.  Any words of wisdom?  Below are selected
> pictures.
>
> Ed Bender, MD
>
>
>
>
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