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European Journal of Echocardiography Advance Access published online on April 21, 2008
European Journal of Echocardiography, doi:10.1093/ejechocard/jen153
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

Echo-guided percutaneous coil embolization of a symptomatic massive metastasis of a renal cell carcinoma in the right ventricular outflow tract

T. Butz1,3,*, H.K. Schmidt1, D. Fassbender1, H. Esdorn2, M. Wiemer1, D. Horstkotte1 and L. Faber1

1 Department of Cardiology, Heart and Diabetes Center North Rhine–Westphalia, Ruhr University Bochum, Georgstr. 11, D-32545 Bad Oeynhausen, Germany
2 Institute of Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Center North Rhine–Westphalia, Ruhr University Bochum, Georgstr. 11, D-32545 Bad Oeynhausen, Germany
3 Department of Cardiology and Angiology, Medizinische Klinik II, Ruhr-University Bochum, Hölkeskampring 40, D-44625 Herne, Germany

Received 21 January 2007; accepted after revision 21 March 2008.

* Corresponding author. Tel: +49 23 234 990. E-mail address: thomas.butz{at}marienhospital-herne.de


  Abstract

We present the case of a 41-year-old woman who was admitted to our centre with progressive symptoms of congestive heart failure (NYHA class III) 5 years after a radical nephrectomy for renal cell carcinoma. Magnetic resonance imaging demonstrated a 5  x  3 cm homogeneous intracardial mass causing right ventricular outflow tract obstruction, not accessible to surgical resection. Serial echo-guided, percutaneous coil embolization of the cardial metastasis was performed with Contour SE Microparticles® (150–250 or 300–500 µm) after identification of the target region of the metastasis by contrast injection (Levovist®) through the balloon catheter into the coronary artery under transoesophageal echocardiographic control prior to induction of the necrosis, corresponding to the technique which has been described for septal ablation in hypertrophic obstructive cardiomyopathy. Follow-up after serial embolization showed a good haemodynamic and a marked clinical response (dyspnoea NYHA I–II) which lasted during the 19 month of survival after the index procedure.

Keywords: Renal cell carcinoma; Magnetic resonance imaging (MRI); Echo-guided percutaneous coil embolization; Cardiac metastasis; Tumour


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