Resection Of Intravenous Leiomyomatosis Invading The Inferior Vena Cava And Right Atrium
Andre Critsinelis, MD, Tyler Warmack, MD, Huy Hoang, MD, Devendra Joshi, MD, Steven DeBeer, MD, Jacob Schwartzman, MD, Edward Andraos, MD, Michael Ayad, MD.
Mount Sinai Medical Center, Miami Beach, FL, USA.
Intravenous leiomyomatosis is an extremely rare benign gynecological tumor which can extend up the IVC into the right atrium/ventricle and pulmonary arteries. Its lack of adherence to the vessel wall makes resection feasible, although extent of invasion may make it technically challenging. A 43-year-old female who recently underwent robotic hysterectomy for abnormal uterine bleeding was found to have intravenous leiomyomatosis on pathology. Post-hysterectomy imaging revealed mass to extend from the right gonadal vein, up the inferior vena cava (IVC), into the right atrium. Patient had experienced syncopal episodes from cardiac arrhythmias warranting prompt excision. Multidisciplinary resection was performed with use of cardiopulmonary bypass (CPB). Femoral venogram was performed to identify distance from access site to tumor for venous CBP sheath selection (a shorter arterial cannula needed to be used). Exploratory laparotomy with right medial visceral rotation and IVC exposure was performed, followed by sternotomy and initiation of CPB with second venous cannula inserted to the right atrium. As intravenous leiomyomatosis does not adhere to the vessel wall, tumor could be resected with manual assistance after venotomy, followed by IVC and atriotomy repair. Patient ultimately also required tricuspid valvuloplasty for severe regurgitation after tumor resection. Patient was successfully weaned off CPB, transferred to the surgical ICU in stable condition. She was extubated on postoperative (POD) 1, and discharged home in good condition on POD8.
Back to 2023 Abstracts