Occlusion of the pulmonary artery by a primary pulmonary artery sarcoma resulting in cardiac arrest: a case report

BACKGROUND: Primary pulmonary arterial sarcoma (PPAS) is a rare condition. Although resection is recommended to improve prognosis, optimal anesthesia management for these cases remains unclear. CASE PRESENTATION: A 62-year-old woman with a diagnosis of left pulmonary PPAS underwent surgical tumor resection and left lung pneumonectomy. Preoperative symptoms included a cough and hemoptysis. Computed tomography revealed a complete obstruction of the left pulmonary artery, with tumor extension into the right pulmonary artery, and mild tricuspid regurgitation was observed on the echocardiogram. Ninety minutes after anesthesia induction, the patient went into cardiopulmonary arrest. As the surgical field was sterilized, we proceeded with emergent sternotomy and cardiac massage. Extracorporeal circulation was established, and surgery proceeded once spontaneous circulation was recovered. The patient survived without neurological complications. CONCLUSIONS: Based on our experience and in the absence of evidence-based guidelines, the femoral artery and vein should be cannulated in all cases for extracorporeal circulation initiation before anesthesia induction.