Hemodynamic collapse under anesthesia in a patient with pulmonary artery sarcoma

To describe a case of acute right ventricular dysfunction and hemodynamic collapse under general anesthesia in a patient undergoing resection of a pulmonary artery sarcoma.

A 67-yr-old woman with a presumptive diagnosis of pulmonary embolism presented to the hospital with progressive shortness of breath and syncope despite therapeutic anticoagulation. An echocardiogram revealed a large mass in the main pulmonary artery and a right ventricular systolic pressure of 105 mmHg. She was referred to our centre for urgent surgical management. One hour following induction of general anesthesia, the patient sustained sudden hemodynamic collapse. Transesophageal echocardiography revealed massive right ventricular dilation, effectively producing tamponade of the left ventricle. Urgent pericardiotomy was performed with immediate hemodynamic recovery. After initiation of cardiopulmonary bypass, the patient was found to have a large pulmonary artery sarcoma involving the pulmonary valve. Following successful resection with grafting and pulmonary valve replacement, the patient's trachea was extubated the following day, and she was discharged from hospital 1 week later in satisfactory condition.

Pulmonary artery sarcomas pose rare and unique challenges to the anesthesiologist. Given the high perioperative mortality, careful monitoring for catastrophic acute cor pulmonale is crucial. Urgent pericardiotomy or cardiopulmonary bypass for sudden hemodynamic collapse may be life-saving components of intraoperative management.