Successful Emergency Cardiac Surgery for Intraoperative Pulmonary Artery Tumor Embolism During Renal Cell Carcinoma...

Intraoperative tumor thrombus embolization during renal cell carcinoma (RCC) surgery with inferior vena cava (IVC) tumor thrombus is a rare but potentially fatal complication. We report successful emergency cardiac surgery for massive pulmonary artery tumor embolism.

A 75-year-old female with left RCC and IVC tumor thrombus underwent radical nephrectomy. Pre-existing left pulmonary artery tumor embolism was noted preoperatively. During IVC manipulation, the tumor thrombus dislodged and migrated through the right heart to completely occlude the right pulmonary artery, causing cardiac arrest. Through multidisciplinary collaboration, nephrectomy was completed under cardiac massage, followed by emergency cardiopulmonary bypass and pulmonary artery thrombectomy. The patient recovered completely without neurological sequelae.

This case demonstrates the critical importance of preoperative risk assessment, intraoperative transesophageal echocardiography monitoring, and immediate multidisciplinary decision-making in managing this life-threatening complication. The "double hit" mechanism of pre-existing and acute pulmonary embolism significantly worsened the clinical course.