2024 FSA Podium and Poster Abstracts
P102: THE ROLE OF TRANSESOPHAGEAL ECHOCARDIOGRAPHY IN THE ANESTHETIC MANAGEMENT OF A COMPLEX VASCULAR TUMOR RESECTION: A CASE REPORT
Valencia T Henry, MS1; Johnathan R Renew, MD2; Monica Mordecai, MD2; 1Edward Via College of Osteopathic Medicine-Carolinas Campus; 2Mayo Clinic Florida
Introduction: Transesophageal echocardiography (TEE) is a valuable tool in guiding the management of complex cardiovascular surgeries, providing detailed imaging of cardiac structures and real-time assessment of hemodynamics. Here, we present a case where TEE played a pivotal role in the surgical management of a patient with a large pulmonary angiosarcoma requiring radical debulking surgery.
Case Presentation: We present a case of a 38-year-old male who is a lifetime nonsmoker with no pertinent past medical history who presented for progressive dyspnea for several months. He was diagnosed with a suspected blood clot of his right lung and prescribed anticoagulants. His breathing improved briefly, but on reimaging the lesion was still present and his symptoms persisted. He was admitted with an episode of hemoptysis and bronchoscopy was negative for lesions. At this time the patient admitted to 50lb weight loss and fatigue which prompted a PET/CT scan that showed a large mass in the right pulmonary artery consistent with pulmonary angiosarcoma. Surgical debulking of the tumor was planned and intraoperative transesophageal echocardiography (TEE) revealed a massive tumor in the right pulmonary artery, extending into the left atrium and closely abutting the aortic root and left main coronary artery. The tumor was larger than anticipated and TEE allowed for real-time imaging and hemodynamic monitoring while ensuring coronary blood flow was not compromised. Additionally, TEE helped monitor for potential complications, such as pericardial effusion and guided the management of hemodynamic instability with vasopressor support. Following resection with pneumonectomy, the patient was successfully weaned from cardiopulmonary bypass without complications and TEE showed preserved cardiac function. The patient was extubated on postoperative day 2 and transferred out of the ICU on postoperative day 3. The patient is recovering well, and the final pathology results are pending.
Discussion/Conclusion: In the context of radical debulking surgery for pulmonary angiosarcoma, TEE assumes multifaceted significance. Firstly, it facilitates a comprehensive assessment of cardiac function, guiding hemodynamic optimization and ensuring intraoperative stability. Secondly, TEE offers unparalleled visualization of tumor invasion into adjacent structures, aiding in surgical planning and execution. By delineating tumor margins and assessing the extent of vascular involvement, TEE empowers surgeons to navigate complex anatomical terrain with precision. Additionally, TEE serves as an invaluable tool for detecting intraoperative complications such as pericardial effusion, enabling prompt intervention and mitigation of adverse events. In the era of advanced surgical techniques, the integration of TEE into the perioperative management of complex cardiovascular procedures is paramount. This case highlights the indispensable role of TEE in guiding anesthetic management and facilitating successful surgical outcomes in patients undergoing radical debulking surgery for invasive pulmonary angiosarcoma. Moving forward, continued emphasis on multidisciplinary collaboration and utilization of TEE in challenging surgical scenarios is imperative for optimizing patient care and achieving favorable treatment outcomes.
Key Words: Transesophageal echocardiography (TEE), pulmonary angiosarcoma, anesthetic management, radical debulking surgery.