Intravenous leiomyomatosis (IVL) originating from the uterus with extension into the cardiac chambers is an extremely rare clinical entity, and cases involving severe right-sided cardiac involvement are particularly uncommon; this report aims to document this rare presentation and its management for clinical reference. A patient presented with clinical manifestations of right heart dysfunction, and auxiliary examinations identified severe cardiac involvement secondary to uterine IVL. The patient was diagnosed with uterine intravenous leiomyomatosis with extensive extension into the right cardiac chambers, complicated by very severe tricuspid regurgitation. A combined multidisciplinary surgical approach was performed, including resection of the right atrial mass, tricuspid annuloplasty ring implantation, exploration and resection of the inferior vena cava lesion, total hysterectomy, and bilateral salpingo-oophorectomy. The surgical intervention was successful, and the patient achieved a favorable clinical recovery with good postoperative condition. This is the first reported case detailing this rare and severe presentation of uterine IVL with extensive right cardiac extension. Recognition of this unusual manifestation of IVL is critical for timely diagnosis and the formulation of a comprehensive surgical treatment strategy. Multidisciplinary collaboration is essential for the successful management of such complex cases.
Yang et al. (Fri,) studied this question.