Uterine leiomyoma with cardiac extension: anesthetic management

A 61-year-old woman complaining of dyspnea with moderate effort was diagnosed with intravenous leiomyomatosis arising in the inferior vena cava with right auricular extension. Surgery was performed in a one-stage procedure under extracorporeal circulation using atriotomy and venotomy of the inferior vena cava. Complete removal of the tumor was confirmed by transesophageal echocardiography during surgery. A femoral venous bypass graft to the root of the aorta allowed the effects of clamping the inferior vena cava to be attenuated and the use of blood products to be reduced. Intravenous leiomyomatosis is a rare benign tumor characterized by smooth muscle proliferation, sometimes involving the inferior vena cava and, very rarely, extending to the right heart chambers.