Anesthesia management for a giant ovarian tumor complicated with heart failure: a case report

BACKGROUND: Large tumors can induce severe cardiopulmonary impairment owing to mechanical compression. In extreme cases, chronic compression can precipitate or exacerbate heart failure, a rare but life-threatening complication that significantly increases perioperative risk. Anesthetic management of patients presenting with both massive tumors and consequent heart failure is exceptionally complex. This case report describes the successful multidisciplinary management of a patient with a giant ovarian tumor and secondary heart failure, highlighting the systematic approach to anesthesia. CASE PRESENTATION: A 54-year-old female presented with severe abdominal distension and dyspnea due to a giant ovarian tumor causing chronic heart failure. She underwent tumor resection under general anesthesia. Given the critical physiology of tumor compression and heart failure, specialized anesthetic management was crucial. This included positioning the patient’s reverse Trendelenburg with a left lateral tilt., using anesthesia induction agents (etomidate and remimazolam), implementing a lung-protective ventilation strategy, and performing transesophageal echocardiography (TEE) to guide precise goal-directed fluid therapy. During surgery, 18 L of cystic fluid was drained slowly over 90 min to prevent decompression-induced hypotension, and aggravation of heart failure. The surgery lasted for 5 h. The patient recovered smoothly, was extubated, and discharged three weeks postoperatively. CONCLUSIONS: For patients with giant abdominal tumors and significant physiological compromise, a comprehensive individualized anesthetic plan encompassing postural positioning, drug selection, liquid management, and controlled decompression is essential for maintaining cardiopulmonary stability and ensuring perioperative safety.