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Uterine Leiomyomatosis With Intracardiac Extension: One-Stage Surgical Approach.

Pablo Del Canto Peruyera¹, Manuel Javier Vallina-Victorero Vázquez¹

¹Angiology, Vascular and Endovascular Surgery, University Hospital of Cabueñes, Gijón, Spain.

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Summary

Intravenous leiomyomatosis, a rare benign tumor, can extend to the heart, posing a life-threatening risk. A single-stage surgery using cardiopulmonary bypass successfully removed an intracardiac tumor in a patient.

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Area of Science:

Cardiovascular Surgery
Vascular Oncology
Gynecologic Oncology

Background:

Intravenous leiomyomatosis (IVL) is a rare benign smooth muscle tumor originating from the uterus.
Intracardiac extension of IVL is uncommon but presents a significant, life-threatening clinical challenge.
Previous hysterectomy for uterine myomatosis does not preclude the development of IVL.

Observation:

A 41-year-old woman presented with a pelvic mass connected to the venous system via the right internal iliac vein.
The pelvic mass demonstrated extension into the right pulmonary artery, indicating intracardiac involvement.
The patient had a history of hysterectomy for uterine myomatosis.

Findings:

A successful single-stage surgical resection of the pelvic mass and intravenous tumor was performed.
Cardiopulmonary bypass was utilized during the procedure to ensure patient safety.
The patient recovered well and was asymptomatic upon discharge.

Implications:

A single-stage surgical approach for intracardiac IVL is a viable and safe option for patients in good general condition.
The use of cardiopulmonary bypass is crucial for preventing complications such as ischemia and embolization.
Multidisciplinary surgical teams are essential for managing complex cases of intravenous leiomyomatosis.