Right-Sided Cardiac Tumors and Awake Femoro-femoral Bypass

Intracardiac tumors are rare and heterogeneous both in pathology and clinical presentation. Primary cardiac tumors are particularly rare, encompassing about 5% of all intracardiac tumors. The overwhelming majority of intracardiac tumors are metastatic. The clinical presentation of these tumors is variable and can range from asymptomatic or vague constitutional symptoms to overt heart failure or sudden cardiac death. Right-sided intracardiac tumors may lead to obstructive symptoms due to impedance of forward flow through the right atrium, tricuspid valve, or right ventricle (RV). This can lead to the clinical signs and symptoms of right-sided heart failure. The tumor itself, or thrombus that has aggregated on a tumor, also can embolize distally into the pulmonary circulation. The successful intraoperative management of intracardiac tumors is dependent on the location of the lesion and its sequelae, such as mass effect, obstruction, valvular involvement, and pericardial tamponade. The authors describe two cases of obstructing right-sided intracardiac tumors in which awake peripheral cannulation for cardiopulmonary bypass (CPB) before induction of general anesthesia was initiated. Informed consent was obtained from both patients.