Malignancy-Induced Functional Tricuspid Obstruction Complicated by Cardiopulmonary Collapse Treated Using Combination...

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Oncology

Background:

• Right-sided intracardiac masses, often metastatic, can cause severe hemodynamic instability and obstructive shock.
• Metastatic disease infiltrating the central venous system is a common origin for these masses.

Observation:

• A case of intracardiac tumor causing tricuspid valve obstruction and shock with cardiac arrest was managed.
• The patient required venoarterial (VA) extracorporeal membrane oxygenation (ECMO) for resuscitation.

Findings:

• Percutaneous large-bore vacuum-assisted aspiration thrombectomy was used to aspirate the intracardiac tumor.
• This procedure, combined with VA ECMO, successfully stabilized the patient hemodynamically.
• The intervention also provided rapid tissue diagnosis crucial for subsequent management.

Implications:

• Large-bore aspiration thrombectomy is a viable therapeutic option for intracardiac masses causing obstructive shock.
• The combination of aspiration thrombectomy and VA ECMO can be life-saving in critical obstructive shock scenarios.
• A multidisciplinary approach is essential when considering aggressive interventions for metastatic disease in critically ill patients.