One-stage Surgery for Intracardiac Leiomyomatosis

INTRODUCTION: Intracardiac leiomyomatosis is a rare, histologically benign, but biologically aggressive tumor developed from uterus. This study aimed to summarize our experience with one-stage surgery for intracardiac leiomyomatosis. METHODS: We retrospectively reviewed seven patients who underwent surgical treatment for intracardiac leiomyomatosis between May 2016 and November 2021. RESULTS: All seven patients were female, aged 35 to 57 years. All lesions in the veins and cardiac chambers were removed entirely. Four of the seven patients received tumor thrombectomy through an abdominal approach. The other three patients received median sternotomy and cardiopulmonary bypass. No perioperative deaths or serious complications occurred during the observation period. The mean operation time in the abdominal approach group was shorter than that in the cardiopulmonary bypass group (308.9 ± 93.2 minutes vs. 486.3 ± 108.6 minutes; P=0.031). Blood loss during surgery in the abdominal approach group was less than that in the cardiopulmonary bypass group (1625 ± 216 mL vs. 2500 ± 1080 mL; P=0.148). All seven patients were free from tumor recurrence or death during the follow-up. CONCLUSION: For patients with intracardiac intravenous leiomyomatosis single-stage operation through an abdominal approach under the surveillance of intraoperative transesophageal echocardiography without the need for cardiopulmonary bypass for specified patients is feasible. Patients in the abdominal approach group can benefit from a shorter operation time and less blood loss. In our small series of varied presentations and tumor extent, we have been able to avoid two-stage surgery, because even short-term interval between the two operations may result in recurrence.