右心房轉移性肝細胞癌於麻醉誘導中發生右心室出口阻塞之病例報告

Metastatic Hepatocellular Carcinoma of the Right Atrium Causing Right Ventricular Outflow Tract Obstruction during Induction of Anesthesia-- A Case Report

心臟內的腫瘤並不常見而且可能導致術中或術後致命的併發症。一位六十一歲的女性接受心臟腫瘤的切除手術。這個轉移性的肝細胞癌是由右心房壁長出來，並且很不幸地在麻醉誘導當中掉入右心室中。這個右心房腫瘤所造成的右心室出口阻塞很快地被經食道超音波診斷出來。這位病患馬上接受了緊急的體外循環術而且順利地完成了手術。我們在這篇病例報告中討論了關於此一事件的可能原因，而且我們建議在這類病人身上應該對於麻醉的技術及考量上要更加的謹慎。

Metastatic hepatocellular carcinoma (HCC) to the right atrium occurs rarely and may lead to lethal perioperative complications. A 61-year-old female who was about to undergo operation for resection of a right intraatrial tumor thought possibly to be metastatic hepatocellular carcinoma met with sudden protrusion of the tumor from the right atrial wall that sank into the right ventricle during induction of anesthesia. Right ventriclular outflow tract obstruction developed and was quickly diagnosed by transesophageal echocardiography. Emergent cardiopulmonary bypass was rushed on the spot and the surgery was completed smoothly. Here we discuss the possible causes of the event and we recommend that special attention should be paid to the anesthetic techniques and proper precaution should be taken in the face of such a risky surgery.