{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T13:52:52Z","timestamp":1785765172783,"version":"3.56.0"},"reference-count":10,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>This case report describes the successful perioperative anesthetic management of a 60-year-old woman with Mayo Level IV clear cell renal cell carcinoma and sickle cell trait who underwent radical nephrectomy, inferior vena cava thrombectomy, and right atrial thrombus excision under cardiopulmonary bypass. The anesthetic challenges included a large intracardiac mass with a high probability of producing mechanical obstruction across the right ventricular inflow and embolization, risk of massive hemorrhage, and perioperative concerns related to sickle cell trait. Intraoperative transesophageal echocardiography helped in thrombus surveillance, vascular access, cannulation guidance, and tumor clearance verification. Surrogate markers identified a subclinical hemolytic event.<\/jats:p>","DOI":"10.4103\/aca.aca_215_25","type":"journal-article","created":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T19:00:23Z","timestamp":1783969223000},"page":"402-407","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Intraoperative Echocardiography as a Cornerstone in Anesthetic Care for Mayo Level IV Clear Cell Renal Cell Carcinoma with Cavoatrial Invasion in a Patient with Sickle Cell Trait"],"prefix":"10.4103","volume":"29","author":[{"given":"Avinash","family":"Chauhan","sequence":"first","affiliation":[{"name":"Department of Cardiac Anesthesia, National Heart Center, Royal Hospital, Muscat, Oman"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madan M.","family":"Maddali","sequence":"additional","affiliation":[{"name":"Department of Cardiac Anesthesia, National Heart Center, Royal Hospital, Muscat, Oman"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Swaroopa","family":"Ghatnatti","sequence":"additional","affiliation":[{"name":"Department of Cardiac Anesthesia, National Heart Center, Royal Hospital, Muscat, Oman"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Is\u2019haq","family":"Al Aamri","sequence":"additional","affiliation":[{"name":"Department of Cardiac Anesthesia, National Heart Center, Royal Hospital, Muscat, Oman"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,7,13]]},"reference":[{"key":"R1-20260803","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1111\/j.1464-410X.2004.04897.x","article-title":"The mayo clinic experience with surgical management, complications and outcome for patients with renal cell carcinoma and venous tumour thrombus","volume":"94","author":"Blute","year":"2004","journal-title":"BJU Int"},{"key":"R2-20260803","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1111\/j.1540-8191.2009.00887.x","article-title":"Deep hypothermia and circulatory arrest in the surgical management of renal tumors with cavoatrial extension","volume":"24","author":"Dedeilias","year":"2009","journal-title":"J Card Surg"},{"key":"R3-20260803","first-page":"60","article-title":"The not-so-benign sickle cell trait: A case of renal medullary carcinoma","volume":"14","author":"Halilu","year":"2024","journal-title":"J Community Hosp Intern Med Perspect"},{"key":"R4-20260803","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1177\/021849230601400113","article-title":"Cardiopulmonary bypass without preoperative exchange transfusion in sicklers","volume":"14","author":"Maddali","year":"2006","journal-title":"Asian Cardiovasc Thorac Ann"},{"key":"R5-20260803","doi-asserted-by":"crossref","first-page":"1633","DOI":"10.1213\/ane.0b013e3181734147","article-title":"Intraoperative transesophageal echocardiography diagnosis of residual tumor fragment after surgical removal of renal cell carcinoma","volume":"106","author":"Martinelli","year":"2008","journal-title":"Anesth Analg"},{"key":"R6-20260803","doi-asserted-by":"crossref","first-page":"468","DOI":"10.1007\/s12630-011-9480-z","article-title":"Intraoperative migration of an inferior vena cava tumour detected by transesophageal echocardiography","volume":"58","author":"Sharma","year":"2011","journal-title":"Can J Anaesth"},{"key":"R7-20260803","doi-asserted-by":"crossref","first-page":"417","DOI":"10.4103\/0259-1162.158011","article-title":"Management of acute intra-operative thromboembolism in renal cell carcinoma","volume":"9","author":"Gharde","year":"2015","journal-title":"Anesth Essays Res"},{"key":"R8-20260803","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1053\/j.jvca.2023.09.013","article-title":"Tricuspid Annular Plane Systolic Excursion (TAPSE) for the assessment of right ventricular function in adult and pediatric cardiac surgery: Modified two-dimensional and M-mode TAPSE by transesophageal echocardiography compared to M-mode TAPSE by transthoracic echocardiography","volume":"38","author":"Munaf","year":"2024","journal-title":"J Cardiothorac Vasc Anesth"},{"key":"R9-20260803","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1016\/0888-6296(88)90273-6","article-title":"Atrial myxoma: Case report, brief review, and recommendations for anesthetic management","volume":"2","author":"Johns","year":"1988","journal-title":"J Cardiothorac Anesth"},{"key":"R10-20260803","doi-asserted-by":"crossref","first-page":"1126822","DOI":"10.3389\/fcvm.2023.1126822","article-title":"Anesthetic management of patients undergoing cardiac myxoma resection: A single-center retrospective analysis","volume":"10","author":"Qi","year":"2023","journal-title":"Front Cardiovasc Med"}],"container-title":["Annals of Cardiac Anaesthesia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/aca.aca_215_25","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T13:10:55Z","timestamp":1785762655000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/aca.aca_215_25"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":10,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.4103\/aca.aca_215_25","relation":{},"ISSN":["0971-9784","0974-5181"],"issn-type":[{"value":"0971-9784","type":"print"},{"value":"0974-5181","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7]]},"assertion":[{"value":"2025-08-08","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-10-11","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}