Anesthetic Management of Intravenous Leiomyomatosis With Intracardiac Extension Using Preemptive Cardiopulmonary Bypass: A Case Report

Intravenous leiomyomatosis (IVL) with intracardiac extension can cause circulatory collapse during anesthetic induction due to right heart obstruction. We report the case of a 63-year-old woman with IVL extending into the right ventricle, presenting with right heart failure and shock. To maintain hemodynamic stability and facilitate tumor resection, we established cardiopulmonary bypass (CPB) under local anesthesia before inducing general anesthesia. Preoperative imaging revealed a tumor extending from the right ovarian vein to the right ventricle, causing circulatory failure. In the operating room, CPB was initiated via femoral cannulation under local anesthesia with analgosedation to maintain spontaneous breathing, followed by general anesthesia induction. A median sternotomy was performed, and an additional venous cannula was placed in the superior vena cava to achieve total CPB. The tumor was resected from the right heart and inferior vena cava. The patient was weaned from CPB and ventilation without complications. Pathology was later confirmed to be IVL. She was discharged on postoperative day 30. Establishing CPB before anesthetic induction maintained hemodynamic stability in this patient with IVL, intracardiac extension, and right heart failure, allowing for safe tumor resection.