Management of Wilms’ Tumor with Cavoatrial Extension Using Deep Hypothermic Cardiac Arrest and Selective Antegrade Cerebral Perfusion

Abstract

ABSTRACT Wilms’ tumor is one of the most common genitourinary malignancies in children. It may be associated with extension of the tumor in the inferior vena cava (IVC) (4%–8%) and right atrium (1%–3%) of cases. In such a scenario, management of cases is further challenging and involves a multidisciplinary approach with medical and surgical specialties, including pediatric cardiac surgery involvement. We present a case of successful management of Wilms’ tumor involving the IVC, right atrium, and hepatic veins where we achieved synchronous surgical resection of both renal and vascular extension. Case management involved anticipated complications involving temperature management, fluid balance, and hemodynamic fluctuation due to intermittent IVC compression, bleeding, arrhythmias, complications involving deep hypothermic cardiac arrest and selective antegrade cerebral perfusion and possibility of tumor embolism.