65 year old Ex-BSF inspector operated for extraction of a rare tumor at Fortis Hospital Anandapur

This is a very interesting case of a 65-year old ex-inspector from the BSF, who worked in Kargil and was involved in the Kargil war as well. In the last 15 days, he was complaining of sudden loss of consciousness and breathlessness. There have been 3-4 instances of him collapsing due to the sudden loss of consciousness and breathing trouble, post which, he would wake up and start normal routine work. He was thus investigated at a private hospital, where he was diagnosed to have a possible left kidney tumor along with involvement of a possible tumor in the heart as well. Reports of CT Scan and MRI confirmed that there was malignant tumor in the kidney, which was extending right inside the heart chambers ie. the Right Atrium and the Right Ventricle. This was diagnosed to be the basic cause of his loss of consciousness and collapse. He was advised immediate surgery, which after being refused by two private hospitals in the city, took place at Fortis Anandapur.

The patient, on arrival at Fortis Anandapur, was taken under the care of Dr. Asok Dhar- Senior Consultant at Fortis Hospital Anandapur, who also involved Dr. K. M. Mandana- Director of the Department of Cardiac Sciences at Fortis Hospital Anandapur. An angiography was conducted to take a look at the heart and the heart vessels to confirm the presence of the tumor inside the heart as well. The big tumor was covering the Right Atrium and the Right Ventricle and was connected to the left kidney tumor right through the Inferior Vena Cava (IVC). The tumor was actually coming from the left kidney into the IVC and had already reached the heart chambers, which is a very rare case and was the actual cause of the repeated collapse of the patient.

The cardiac team decided to involve Dr. Srinivas Narayan- Director of the Department of Urology and Renal Transplantations at Fortis Hospital Anandapur as the renal extraction procedure would have to be conducted. The holistic team comprising of cardiac surgeon, urologist and cardiac interventionist together planned out the best line of treatment for the patient. The patient party was also counseled about the disease of the patient, which was an asymptomatic renal cell carcinoma tumor, often known to extend from the kidney through the IVC, to finally reach the heart chambers.

Describing the surgery, Dr. Mandana said, “It was a very rare and challenging surgery, where the tumor has not only reached the heart but has also gone inside the two chambers of the heart. The size of the said tumor was 7 inches long from the IVC to the heart. The cardiac team decided to go for a Total Circulatory Arrest or Deep Hypothermic Circulatory Arrest, where the patient’s body was cooled to 18-20°C and all the blood from the body is drained out. After this, the kidney was removed along with the tumor, the IVC was opened up to clean it off the tumor and finally the right atrium of the heart is opened to remove the entire tumor from the right atrium and the right ventricle. The role of the perfusionist is very significant in such cases as he handles the patient and the temperature while the operation is being performed. This operation carried on for a total span of around 6 hours, which included 25mins of Deep Hypothermic Circulatory Arrest. The patient has recovered well post-surgery and is currently in the ICU. His brain and heart conditions along with the urinary functions are normal.”

Explaining the rarily of such a case, Dr. Mandana exclaimed, “We have had around 5-6 cases in our hospital with urologists but they were all right-sided tumors, but left side kidney tumor is rare and left side of kidney tumor entering into the IVC is rarer. However, left side kidney tumor entering the heart is hardly seen and has an incidence of around 0.03% of all the renal tumors entering the heart.”

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