Urgent resection of hepatocellular carcinoma with intracardiac extension under moderate hypothermic circulatory arrest

Abstract

Intracardiac extension of hepatocellular carcinoma (HCC) via the inferior vena cava (IVC) is uncommon and may result in fatal cardiac complications. We report a case of urgent cardiac surgery performed to prevent imminent cardiac deterioration and facilitate subsequent multidisciplinary treatment. A 64-year-old man with a history of right hepatectomy for stage III HCC and radiofrequency ablation for recurrent disease was admitted following a traffic accident. Echocardiography revealed a 4.6 × 3.6 cm right atrial mass continuous with the IVC. Although the patient had no overt cardiac symptoms, frequent episodes of non-sustained ventricular tachycardia and bilateral lower extremity oedema raised concern regarding impending cardiac complications. Urgent tumour resection was performed under moderate hypothermic circulatory arrest (lowest rectal temperature, 32 °C). Following cardiac and orthopedic surgery, the patient underwent transcatheter arterial chemoembolization and systemic therapy with durvalumab plus tremelimumab. At 1-year follow-up, no intracardiac recurrence was observed, pulmonary metastatic lesions had regressed, and the patient remained clinically stable. Urgent cardiac surgery may serve as a bridge to multidisciplinary treatment in selected patients with HCC and intracardiac extension.