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Multistage Excision of Intravascular Leiomyoma With Extension Into the Right Atrium.

Jonathan A Reimer1, Paige Blinn2, Hesham Tanbour2

  • 1Department of Surgery, Mount Sinai Hospital, Chicago, Illinois, USA; Department of Surgery, University of Illinois at Chicago, Chicago, Illinois, USA.

JACC. Case Reports
|July 18, 2025
PubMed
Summary

Intravascular leiomyoma (IVL) is a rare tumor that can extend into the heart. A staged surgical approach is recommended for complete tumor removal and to prevent sudden cardiac death.

Keywords:
cardiac tumorintracardiac leiomyomatosisintravascular leiomyoma

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Area of Science:

  • Cardiovascular Surgery
  • Gynecologic Oncology
  • Vascular Surgery

Background:

  • Intravascular leiomyoma (IVL) is a rare, benign neoplastic proliferation originating from smooth muscle tissue.
  • IVL commonly arises from the uterus and can invade adjacent venous structures, potentially extending intracardiacly.

Observation:

  • A 56-year-old woman presented with an IVL extending into the right atrium and ventricle.
  • The tumor caused significant venous obstruction, posing a risk of sudden cardiac death.

Findings:

  • A staged surgical excision was performed, initially addressing the intracardiac and suprahepatic tumor components.
  • A subsequent laparotomy 6 weeks later completed the excision, including the pelvic mass, bilateral oophorectomy, and caval thrombectomy.

Implications:

  • Complex IVL cases necessitate a multidisciplinary approach involving cardiologists, radiologists, and surgical specialists.
  • A staged surgical strategy is advisable for managing extensive IVL, allowing for careful planning and execution.