| A Case of Intravenous Leiomyomatosis
Extending into the Right Ventricle through the Internal Iliac
Vein and Inferior Vena Cava |
(First Department of Surgery, Chiba University School
of Medicine, Chiba, Japan)
| Toshiaki Ohto |
Masahisa Masuda |
Naoki Hayashida |
| Yoko Pearce |
Mitsuru Nakaya |
Hideo Ukita |
| Hitoshi Shimura |
Kenji Mogi |
Yoshihisa Tsukagoshi |
| Nobuyuki Nakajima |
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Intravenous leiomyomatosis (IVL)
is defined as the extension into the venous channels of histologically
benign smooth muscle tumors originating either from a uterine
myoma or from the walls of a uterine vessel. We report a case
of IVL extending to the right atrium and right ventricle through
the right internal iliac vein and the inferior vena cava. The
patient was a 43-year-old woman. The tumor was extirpated by
simultaneous median sternotomy and laparotomy with the use of
cardiopulmonary bypass. It was necessary to use cardiopulmonary
bypass in order to open the right atrium. However, it proved
difficult to insert the venous cannulae into the inferior vena
cava due to the presence of the tumors. In order to perform the
cannulation, a trans-right atrial excision of this tumor was
necessary. Nevertheless, hemodynamic deterioration tended to
occur during the procedure because of unexpected bleeding. We
believe that to safely carry out this operation, it would be
better to ensure circulatory arrest before trans-right atrial
excision of the tumor. We have been continuing preventive anti-estrogen
therapy because recurrence would be very likely if any tumorous
tissue remained after surgery. Fortunately, no intravenous infiltration
of the tumor has been detected by either pelvic computed tomography
or ultrasonography during the 26-month follow-up period. Surgical
excision of the tumors and postoperative medication are now believed
to have been effective.
Jpn. J. Cardiovasc. Surg. 30: 36-39（2001) |
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