Renal carcinoma infiltrating inferior vena cava and combined valvular heart disease - one-stage uro-cardiological proced
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CASE REPORT
WORLD JOURNAL OF SURGICAL ONCOLOGY
Open Access
Renal carcinoma infiltrating inferior vena cava and combined valvular heart disease - one-stage uro-cardiological procedure: a case report Artur A Antoniewicz1, Slawomir Poletajew1*, Andrzej Biederman2, Lukasz Zapala1, Andrzej Borowka1
Abstract Standard treatment of patients with coexisting cardiac and non-cardiac diseases includes two separate operations. We report a case of 55-year-old man with combined valvular heart disease and renal carcinoma infiltrating inferior caval vein, who underwent one-stage cardio-urologic procedure. In the first step, mitral and tricuspid valvuloplasty were performed by cardiac surgeons. Then, urologists performed radical nephrectomy and thrombectomy. The postoperative course was uneventful. In twelve months follow-up the patient shows no signs of reccurrence and he had no symptoms of cardiac disease. To the best of our knowledge such a case has never been reported before in the literature. Background Coexistence of cardiac and non-cardiac diseases requiring surgical treatment has been a matter of debate for many years. The major problem concerns patients suffering from cardiac and oncologic diseases. The strategy of two separate procedures should be taken into consideration when consulting such a case. However, if the cardiac operation is performed first, the oncologic treatment is delayed and the chances for success are poorer. Furthermore, the immunosuppressive effect of extracorporeal circulation may accelerate tumor growth and disseminate cancer cells [1]. If oncologic operation is performed first, the risk of operation is very high due to heart status. There is also an aspect of risk and cost of two hospital stays and additional anaesthesia. In this group of patients, cardiac and non-cardiac operation performed under single anaesthesia seems to be interesting therapeutic option. However, the combined procedure requires thorough operation plan and two experienced, harmonious surgical teams. Some surgeons have started to perform such procedures. Satisfactory results are reported concerning one-stage cardiac operation and pulmonary tumor resection [2], carotid
* Correspondence: [email protected] 1 Department of Urology, The Medical Centre of Postgraduate Education, Warsaw, Poland Full list of author information is available at the end of the article
endarterectomy [3], abdominal aortic aneurysm repair [4], resection of goiter [5] and others. Till now there has been just few publications on onestage cardio-urologic operations [6-9] and there are no reports concerning patients with combined valvular heart disease and urologic tumor.
Case presentation 55-year-old man (height 1,78 m; weight 70 kg) with severe heart failure - NYHA class III/IV was admitted to cardiology department for evaluation for surgery of incompetent mitral and tricuspid valves. Transthoracic echocardiogram confirmed diagnosis of severe mitral and tricuspid incompetence, dilated left ventricle, poor contractility (EF - 40%), pulmonary hyp
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