A new anesthesia management for giant intracardiac and intravenous leiomyomatosis

Intravenous leiomyomatosis is a very rare disease that occurs in women of childbearing age and perimenopausal women. It starts from the wall of the venous blood vessels of the uterus or pelvis, which spread upward along the blood vessels to the inferior vena cava. When the tumor extends into the cardiac chambers, patients are at high risk for perioperative anesthesia when they undergo surgery. A 38-year-old female patient was admitted to the hospital due to recurrent syncope. Transthoracic echocardiography revealed a mass occupying the right atrium and inferior vena cava. The mass prolapsed into the right ventricle through the tricuspid valve. The patient experienced a sudden loss of consciousness and exhibited respiratory arrest with facial and lip cyanosis during general anesthesia induction. We tried a new anesthesia induction method - extracorporeal circulation was established before induction of anesthesia, which allowed the surgery to proceed successfully. This case provides a new ideal for anesthesia management for patients with giant intracardiac and intravenous leiomyomatosis.