Cytoreductive Surgery for Right Ventricular Sarcoma

Welcome to this series of CTSNet videos on Thoracic Surgical Oncology - Technical Approaches, by Professor Tristan D. Yan.

The Royal Prince Alfred Hospital provides the largest thoracic oncology service in New South Wales, Australia.This70-year-old man initially presented with dyspnea and presyncope. CTPA revealed a large obstructive mass within the right ventricle and main pulmonary artery, extending into both left and right pulmonary arteries. Transthoracic echocardiogram demonstrated severe pulmonary hypertension. Histopathology from samples taken at clot retrieval revealed the mass to be an intimal sarcoma. This presentation was further complicated by heparin-induced thrombocytopenia and thrombosis syndrome (HITTS). This video demonstrates the surgical approach and the anesthetic considerations in this patient, who underwent cytoreductive surgery for an extensive right ventricular sarcoma, bilateral pulmonary thromboendarterectomy, pulmonary valve replacement, pulmonary trunk reconstruction, and mitral valve replacement at the Royal Prince Alfred Hospital. The patient had an uneventful recovery.