In August 2003, a 66-year-old man underwent a laparoscopic left nephroureterectomy for a left renal pelvic tumor. Because strong adhesions around the kidney, the operation time was longer than usual. On pathology, the tumor was a pT3,v(+),ly(+) grade 2 transitional cell carcinoma. There was no lymph node metastasis. Postoperatively, the patient received two cycles of adjuvant MEC chemotherapy (methotrexate, 30 mg/m2; epirubicin, 30 mg/m2; cisplatin, 70 mg/m2). On postchemotherapy computed tomography (CT) there was no evidence of local recurrence and no metastases. Seven months after the operation, the patient presented with chest discomfort and shortness of breath. On chest X-ray, an enlarged cardiac silhouette was noted, and the electrocardiogram showed a bradycardia. On echocardiography, slight pulmonary hypertension and a small pericardial effusion, but no asynergy, were noted. The patient was given standard therapy for heart failure but his symptoms failed to improve. One month later, the patient’s symptoms worsened, and the patient was admitted to hospital. On echocardiography, an 8-mm sized mass extending from the right atrium into the right ventricle was seen (Fig. 1). The patient’s pulmonary hypertension had worsened, and the pericardial effusion had increased, but there was no asynergy. On chest CT, multiple lung tumors and a right atrial and ventricular mass were noted (Fig. 2). Shortly thereafter, the patient died as a result of acute heart failure caused by right ventricular outflow tract obstruction. On autopsy, metastases in the lungs, liver, adrenal glands and right atrium and ventricle were noted (Fig. 3). On histology, a grade 2 transitional cell carcinoma was diagnosed (Fig. 4).