Transesophageal Echocardiography-Guided Anesthetic Management of Intravenous Leiomyomatosis With Right Atrial Extension: A Case Report

Intravenous leiomyomatosis (IVL) is a rare benign smooth muscle tumor that can extend into the heart, posing major anesthetic challenges. We report a 57-year-old woman with IVL extending from the uterus through the inferior vena cava into the right atrium. A multidisciplinary team performed single-stage intracardiac tumor resection under cardiopulmonary bypass with hysterectomy and bilateral salpingo-oophorectomy. Continuous transesophageal echocardiography (TEE) enabled real-time assessment of tumor mobility and safe cannulation. The patient recovered uneventfully. This case highlights the essential role of TEE and teamwork in managing IVL with intracardiac extension.