[Anesthetic Management of One-stage Intravenous Leiomyomatosis Resection Extending to the Right Ventricle].

We report a case of 71-year-old female with intravenous leiomyomatosis (IVL) extending to the right ventricle. She was operated on successfully by one-stage approach involving thoracotomy and laparotomy. The important question was whether to perform IVL extraction first, or hysterectomy first; performing hysterectomy before IVL extraction may increase the risk of postoperative infection such as mediastinitis, as well as the risk of intraperitoneal hemorrhage during cardiopulmonary bypass (CPB) and tumor embolism. On the other hand, if IVL extraction is performed first, there is a possibility of bleeding during hysterectomy following CPB. Moreover, in a case of malignant disease, CPB might increase the risk of systemic metastasis. In the present case, IVL extraction was performed first, considering that hysterectomy before IVL extraction would increase the risk of intraoperative complications, and leading to a successful surgery without any problems. In rare cases, such as this one, it is important that surgeons and anesthesiologists recognize the importance of cooperation and careful surgical planning to decrease the perioperative risks.