Severe coagulopathy and inflammation occurred after resection of giant right ventricular intimal sarcoma with cardiopulmonary bypass: a case report

Background: Primary malignant cardiac tumors are rare in clinic, and surgical resection under cardiopulmonary bypass(CPB) is the main treatment. The non-physiological perfusion process of CPB leads to contact activation, and the resulting coagulation dysfunction and systemic inflammatory response syndrome (SIRS) are common complications. However, it is difficult to predict the impact of foreign tumor fragments on this pathophysiological process once they enter the bloodstream, making this phenomenon more complex and challenging. Case Presentation: We report a case of cardiac intimal sarcoma who developed severe coagulopathy and inflammation after excision of massive right ventricular tumor and replacement of tricuspid valve under median sternotomy under CPB. Although the procedure was expected to cause tumor cell necrosis and precautions were taken, uncontrolled massive postoperative bleeding, persistent fever and abnormal elevated inflammatory markers, and repeated malignant arrhythmias occurred after surgery. In addition to common factors, the most possible underlying mechanism is contact activation triggered following surgical procedure for intimal sarcoma with CPB. Conclusion: Patients with intracardiac malignant tumors are at a high risk for serious contact activation during CPB. Preventive application of comprehensive anti-inflammatory measures such as drugs and adsorptive CPB technology, as well as point-of-care (POC) monitoring of coagulation status will be helpful for individualized guidance and optimization of CPB management, and improvement of patient prognosis.