3D­printed template­guided iodine­125 seed implantation to treat complete occlusion of the superior vena cava in pulmonary sarcomatoid carcinoma: A case report.

Pulmonary sarcomatoid carcinoma (PSC), which is a type of non-small-cell lung carcinoma (NSCLC), is characterized by a high degree of malignancy, poor differentiation and a high incidence of pulmonary malignancy. In addition, PSC has a stronger invasive ability than other types of NSCLC and is not sensitive to radiation or chemotherapy. Furthermore, 90% of PSC cases exhibit vascular invasion; therefore, there is a risk of multiple metastases to the lung, bone, adrenal glands and brain, and consequently a poor prognosis, in the early stage. Targeted therapy and immunotherapy currently offer a new treatment direction; however, there have not been any significant advances in localized treatment in recent years. Thus, there is an urgent need for new localized treatment strategies. The present study describes the case of a 65-year-old man with recurrence of PSC after multi-line treatment with chemotherapy, radiotherapy, gamma knife and argon-helium knife treatment. In addition, the patient developed superior vena cava syndrome, and exhibited severe compression of the superior vena cava, chest discomfort, dyspnea and severe facial edema after chemotherapy, local gamma knife therapy (35 Gy, delivered through 14 2.5-Gy doses), argon-helium knife therapy and radiation therapy (28 Gy, delivered through seven 4-Gy doses). Partial remission was achieved after local implantation of iodine-125 (I125) seed under the guidance of a 3D-printed template, with progression-free survival observed up to 8 months afterwards. In conclusion, in patients with PSC who develop superior vena cava blockage after numerous treatment regimens, salvage I125 brachytherapy with a 3D-printed template may be suitable, and may improve local control and symptoms.

Metastatic prostate cancer presenting as generalized lymphadenopathy and progressing with inferior vena cava syndrome: A case report and literature review.

The present study describes the case of a 71-year-old male patient that presented with generalized lymphadenopathy and a pelvic mass, but no signs of bone and visceral metastasis. Their total prostate-specific antigen level was >100 ng/ml. A biopsy of the pelvic mass, situated near the left iliac vessels, confirmed the existence of an adenocarcinoma originating from the prostate and a subsequent prostate biopsy indicated a Gleason score of 4+5. Endocrine treatment with bicalutamide and goserelin (androgen deprivation therapy) resulted in only a partial response of the left iliac metastatic lesions to the treatment. The subsequent treatment plan of androgen deprivation therapy and abiraterone plus docetaxel did not change the progression of the disease. The patient finally developed inferior vena cava syndrome. Subsequently, the patient declined both a re-biopsy of the prostate and enlarged cervical lymph nodes, and interventions by a vascular surgeon. To the best of our knowledge, the present study is the first documented case of a natural progression of metastatic prostate cancer with inferior vena cava syndrome.

Persistent Left Superior Vena Cava: Unanticipated Stumbling Block in Cardiac Resynchronization Therapy.

Persistent left superior vena cava (PLSVC) is a relatively rare anatomical anomaly, with a higher prevalence in those with congenital heart defects. While typically asymptomatic, its presence can complicate certain medical procedures, particularly cardiac interventions, such as the implantation of cardiac resynchronization therapy (CRT) devices, due to acute angulation. In this report, we discuss the challenges posed by the unanticipated presence of PLSVC during CRT device implantation and describe the technique used for lead placement using Judkins Right catheter for support, placing coronary wire, and later placing the left ventricle (LV) lead with the help of buddy wire technique, resulting in successful insertion of all three CRT leads despite the anatomical challenges.

Chylopericardium and Superior Vena Cava Syndrome Caused by Central Venous Occlusion From Indwelling Hemodialysis Catheters.

Chylopericardium is a rare condition. Causes include superior vena cava syndrome resulting from indwelling catheters. We present a case of this condition in a 42-year-old man with end-stage renal disease treated with hemodialysis through a right subclavian vein catheter. He underwent successful endovascular stenting with resolution of his symptoms and chylopericardium.

Sequential Isolation of Persistent Left Superior Vena Cava and Right Superior Vena Cava Using Pulsed-field Ablation with a Pentaspline Catheter for Recurrent Persistent Atrial Fibrillation.

Pulsed-field ablation (PFA) is a novel technology for atrial fibrillation (AF) ablation that can deliver energy precisely with a lower risk of damage to the surrounding organs. Persistent left superior vena cava (PLSVC) is a congenital variant that can act as a driver of AF, and its isolation may be required in recurrent persistent AF. We describe a case where PFA was used for isolation of the right superior vena cava, PLSVC, and posterior wall of the left atrium.

Conversion therapy for hepatocellular carcinoma to improve treatment strategies for intermediate and advanced stages.

This manuscript is based on a case reported by Song et al published in the World Journal of Clinical Cases. Several challenges remain in the field of hepatocellular carcinoma (HCC) conversion therapy. Consequently, only a limited number of patients with HCC accompanied by portal vein tumor thrombosis (PVTT) and hepatic vein tumor thrombosis (HVTT) are eligible for resection. This clinical case demonstrates that considering the complexity of the disease, a multimodal and multidisciplinary approach is essential for managing HCC accompanied by PVTT and HVTT. However, the outcomes of such surgeries remain controversial. In conclusion, research on HCC conversion therapy is extremely useful for improving treatment strategies for intermediate and advanced HCC, which currently have disappointing clinical outcomes.

Incomplete Unilateral Horner's Syndrome Due to Superior Vena Cava Compression Syndrome Caused by Small Cell Lung Carcinoma.

Incomplete unilateral Horner's syndrome due to central small cell lung cancer (SCLC) with consecutive compression of the superior vena cava has not been reported before. A 56-year-old woman with stage T4,N3(cerv),M1a metastatic central SCLC treated with carboplatin and etoposide developed incomplete Horner's syndrome before receiving the first cycle of chemotherapy. Investigation for ptosis ruled out myasthenic syndrome, myasthenia, primary myopathy, facial palsy, and mitochondrial disorders. After congestion developed in the upper inflow area and compression of the superior vena cava was noted, Horner's syndrome was attributed to superior vena cava compression syndrome (SVCCS). Stenting of the stenosis did not result in a complete resolution of Horner's syndrome. In summary, SVCCS can lead to congestion of the jugular veins and subsequent impairment of the centripetal sympathetic fibers that run along the carotid artery. Compression of the sympathetic fibers can lead to incomplete Horner's syndrome with non-fluctuating and non-exercise-induced ptosis. Clinicians should be aware that Horner's syndrome associated with SCLC may be due not only to a myasthenic syndrome but also, in rare cases, to a focal affection of sympathetic fibers.

Comparison of inferior vena cava puncture under continuous cardiac perfusion with cardiac puncture in blood acquisition of the laboratory mouse.

Obtaining sufficient blood volume from mice significantly facilitates experimental research. This study explored the inferior vena cava puncture under continuous cardiac perfusion (IVCP-UCCP) technique and evaluated its efficiency in comparison with conventional cardiac puncture (CP). In an initial dose-finding study, 50 mice were randomly assigned to one of 10 groups with escalating perfusion volume from 0.5 to 4.5 ml in 0.5-ml increments. The minimum perfusion volume was determined to be 2 ml in collecting whole circulating blood. In the next comparison using the conventional method, 40 mice were randomly assigned to one of two groups denoting different blood collection methods: Group 1: CP, Group 2: IVCP-UCCP. The results showed 1) that the cells and undiluted blood volume collected via IVCP-UCCP was over twofold higher than that by CP (p < 0.001), confirmed by the cell counts and hematoxylin-eosin staining of different tissues slides (p < 0.001); 2) the new technique did not alter the cellular composition or viability, which was verified by routine blood tests and flow cytometry (p > 0.05); 3) the blood collected via the novel technique was diluted 2.1 times: the hemato-biochemical indicator results multiplied by 2.1 were identical with the test results of blood from CP (p > 0.05). Together, the refined blood collection method of IVCP-UCCP completely extracted the limited blood resources in mice, significantly enhanced the utilization of each mouse, and thus offered scientific and ethical benefits. This technique may be also applicable for other small animal models.

Treatment of a penetrating inferior vena cava injury using doctor-helicopter emergency medical service and direct-to-operating room resuscitation in Korea: a case report.

Inferior vena cava (IVC) injuries can have fatal outcomes and are associated with high mortality rates. Patients with IVC injuries require multiple procedures, including prehospital care, surgical techniques, and postoperative care. We present the case of a 67-year-old woman who stabbed herself in the abdomen with a knife, resulting in an infrarenal IVC injury. We shortened the transfer time by transporting the patient using a helicopter and decided to perform direct-to-operating room resuscitation by a trauma physician in the helicopter. The patient underwent laparotomy with IVC ligation for damage control during the first operation. The second- and third-look operations, including previous suture removal, IVC reconstruction, and IVC thrombectomy, were performed by a trauma surgeon specializing in cardiovascular diseases. The patient was discharged without major complications on the 19th postoperative day with rivaroxaban as an anticoagulant medication. Computed tomography angiography at the outpatient clinic showed that thrombi in the IVC and both iliac veins had been completely removed. Patients with IVC injuries can be effectively treated using a trauma system that includes fast transportation by helicopter, damage control for rapid hemostasis, and expert treatment of IVC injuries.

DVT with Pulmonary Embolism in Patient with Grade 2 Compound Tibia Shaft Fracture- Treated with Thrombolysis and Use of Prophylactic IVC Filter: Case Report.

Introduction: Major orthopedic procedures place patients at risk for Deep venous thrombosis (DVT) and pulmonary embolism (PE). DVT has a 10-40% incidence after isolated fractures of the tibia and distal bones of the lower extremity. Diagnostic techniques are venous compression ultrasonography, venography, and pulmonary angiography. Prevention methods for venous thromboembolism (VTE) include mechanical prophylaxis and pharmacological prophylaxis. Inferior vena cava filter (IVCF) intercepts thrombus in inferior vena cava and prevents it from reaching the pulmonary artery. Case Report: A 39-year-old female having compound Type 2 mid-shaft tibia fracture and operated with intramedullary nailing at a corporate hospital, Navi Mumbai in January 2024. Despite giving DVT prophylaxis, she developed shortness of breath on 3rd day. 2D echocardiogram (ECHO) showed dilated right atrium and right ventricular and computed tomography pulmonary angiography (CTPA) showed saddle embolism at the junction of pulmonary artery division. The cardiologist immediately advised intravenous (IV) thrombolysis (injection tenecteplase 30 mg stat) followed by IV anticoagulants (injection low molecular weight heparin 0.6) and oral (rivaroxaban 20 mg) for 15 days. However, she complained of high-grade fever, right leg persistent swelling, and per vaginal (PV) bleeding. Venous Doppler showed persistent thrombi. Hence oral rivaroxaban was stopped, and IVCF was inserted in February 2024 to prevent further embolization. After observing her menstrual cycles, she was resumed on oral rivaroxaban after 1 month. Follow-up after 3 months of surgery (April 2024) showed signs of healing of shaft tibia fracture. Follow-up after 3 months of IVCF placement (May 2024) showed no persistent thrombi in bilateral lower limb venous Doppler. Hence decision of F removal was made at 3 months. Conclusion: Clinical evaluation of patients is important for the detection of DVT-PE. Complain of breathlessness on exertion suggested the diagnosis of PE, confirmed by 2D ECHO and CTPA, and immediately treated by the cardiac team with thrombolytics and anticoagulants. Since the patient developed bleeding PV, the insertion of an IVCF is the best option for treatment and prophylaxis of future VTE episodes.

Surgical Strategies and Perioperative Outcomes of Robot-Assisted Vena Cava Reconstruction.

BACKGROUND: This study aimed to describe robot-assisted vena cava reconstruction by summarising surgical strategies and perioperative outcomes. METHODS: A retrospective review was performed on all robotic surgeries involving dissection and repair of the inferior vena cava (IVC) at our institution. Patient characteristics, operative reports, and follow-up visits were analysed. RESULTS: Thirty-nine patients underwent robot assisted surgery of the vena cava from 2016 to 2023. The median postoperative hospital stay of all patients was 7 days, and the median estimated blood loss (EBL) was 550 mL. The median IVC clamping time was 23 min, and IVC wall invasion was pathologically identified in five cases. No patients had liver or kidney dysfunction at the last follow-up. CONCLUSION: Our initial experiences demonstrate that it is safe and feasible for experienced surgeons to perform robot-assisted vena cava reconstruction in highly selected patients.

Inferior vena cava collapsibility index for predicting hypotension after spinal anesthesia in patients undergoing total knee arthroplasty.

OBJECTIVE: This study aimed to identify risk factors associated with hypotension in patients undergoing total knee arthroplasty (TKA) under spinal anesthesia. METHOD: A total of 200 patients (50-75 years of age) who underwent elective TKA under spinal anesthesia between October 2023 and January 2024 were enrolled. Patients were divided into two groups (hypotensive and nonhypotensive) depending on the occurrence of postspinal anesthesia hypotension (PSAH). Patient characteristics (age, sex, body mass index, and medical history), blood pressure, heart rate, and ultrasound data before anesthesia were documented. Multivariate logistic regression models were used to determine risk factors for hypotension after spinal anesthesia. Furthermore, a nomogram was constructed according to independent predictive factors. The area under the curve (AUC) and calibration curves were employed to assess the performance of the nomogram. RESULTS: In total, 175 patients were analyzed and 79 (45.1%) developed PSAH. Logistic regression analysis revealed that variability of the inferior vena cava (odds ratio, OR, 1.147; 95% confidence interval, CI: 1.090-1.207; p < 0.001) and systolic arterial blood pressure (SABP, OR 1.078; 95% CI: 1.043-1.115; p < 0.001) were independent risk factors for PSAH. Receiver operating characteristic (ROC) curve analysis showed that the AUC of the inferior vena cava collapsibility index (IVCCI) and SABP alone were 0.806 and 0.701, respectively, while the AUC of both combined was 0.841. Specifically, an IVCCI of > 37.5% and systolic arterial blood pressure of > 157 mm Hg were considered threshold values. Furthermore, we found that the combination had a better predictive value with higher AUC value, sensitivity, and specificity than the index alone. The nomogram model and calibration curves demonstrated the satisfactory predictive performance of the model. CONCLUSION: Elevated preoperative systolic arterial blood pressure and a higher IVCCI were identified as independent risk factors for hypotension in patients receiving spinal anesthesia, which may help guide personalized treatment.

Management of PFO in paradoxical embolic stroke with hemorrhagic conversion: a case report.

A paradoxical embolism is defined as a venous thrombus that crosses through a heart defect, into the systemic circulation, usually through a patent foramen ovale. Treatment varies between closure of patent foramen ovale vs. medical management based on a variety of individual risk factors and the cardiac defect's characteristics. We describe a case of paradoxical stroke complicated by hemorrhagic conversion, ultimately requiring an IVC filter.

A Practical Approach to the Diagnosis and Initial Management of Acute Right Ventricular Failure during Pregnancy using Point-of-Care Ultrasound.

Acute right ventricular failure is a critical condition in pregnancy that can lead to severe maternal and fetal complications. This expert review discusses the instrumental role of Point-of-Care Ultrasound in diagnosing and managing ARVF in pregnant patients, highlighting its benefits for immediate clinical decision-making in obstetric emergencies. The unique physiological changes during pregnancy, such as increased blood volume and cardiac output, can exacerbate underlying or latent cardiac issues, making pregnant patients particularly susceptible to acute right ventricular failure. Common causes during pregnancy include pulmonary embolism, peripartum cardiomyopathy, and congenital heart diseases, each presenting distinct challenges in diagnosis and management. The real-time capability of point-of-care ultrasound allows for the immediate assessment of right ventricular size and function, evaluation of fluid status via the inferior vena cava, and identification of potential pulmonary embolism, offering a non-invasive, rapid, and dynamic diagnostic tool right at the bedside. The expert review details specific point-of-care ultrasound techniques adapted for pregnant patients, including the parasternal long and short axis and apical four-chamber view, essential for evaluating right heart function and guiding acute management strategies. These include fluid management, adjustment of pharmacological treatment, and immediate interventions to support cardiac function and reduce ventricular overload. Point-of-care ultrasound enhances clinical outcomes by allowing clinicians to make informed decisions quickly, reducing the time to intervention, and tailoring management strategies to individual patient needs. However, despite its apparent advantages, the adoption of point-of-care ultrasound requires specialized training and familiarity with obstetric-specific protocols. This review advocates for the integration of point-of-care ultrasound into standard obstetric care protocols, emphasizing the need for clear guidelines and structured protocols that equip healthcare providers with the skills necessary to utilize this technology effectively. Future research should aim to refine these protocols and expand the evidence base to solidify the role of point-of-care ultrasound in improving maternal and fetal outcomes in acute right ventricular failure.

Percutaneous Balloon Venoplasty for Symptomatic Lead Related Venous Stenosis.

BACKGROUND: Lead-related venous stenosis (LRVS) is common after transvenous lead implantation and generally diagnosed incidentally. Symptomatic LRVS, causing discomfort and swelling, is less common. OBJECTIVE: To report on the management and outcomes of patients with symptomatic LRVS after percutaneous balloon venoplasty METHODS: We included patients with symptomatic LRVS unresponsive to >30 days of anticoagulation who underwent venoplasty at the Hospital of the University of Pennsylvania between 2014 and 2020. Transvenous lead extraction (TLE) was performed first if the lesion could not be crossed with a wire. RESULTS: Eighteen patients (mean 62±10 years, 44% female) underwent 27 venoplasty procedures. Symptoms included arm swelling in 9 (50%), facial/neck swelling in 1 (6%), and both in 8 (44%). Venography revealed LRVS in the axillary/subclavian veins in 10 (56%), the brachiocephalic vein in 6 (33%), and the superior vena cava in 4 (11%). Most patients (83%) required TLE prior to venoplasty and only 5/18 (28%) remained with leads crossing the stenosed segment. Thirteen patients (72%) had complete symptom resolution, four (22%) had partial resolution due to secondary lymphedema, and one showed no improvement. Patients with complete resolution had shorter times from symptom onset to intervention (195 versus 690 days, p=0.02). CONCLUSION: LRVS can affect any part of the venous system and may present with swelling of the arm, face/neck, or both. Balloon venoplasty is safe and effective, often requires TLE, and is particularly durable when leads no longer cross the stenosed region. Venoplasty is less effective for secondary lymphedema, highlighting the need for timely intervention.

Comparing anticoagulant therapy alone, anticoagulant therapy in combination with catheter-directed thrombolysis, and anticoagulant therapy in combination with pharmacomechanical catheter-directed thrombolysis in the patients with optional inferior vena cava filter-related thrombosis: A single-center retrospective study.

OBJECTIVE: To analyze the treatment methods and efficacy of inferior vena cava filter thrombosis (IVCFT). MATERIALS AND METHODS: In this retrospective study, the clinical data for 47 patients with IVCFT who underwent sequential treatment at the Department of Vascular Surgery, Tianjin Medical University Second Hospital, from January 2020 to January 2023 were analyzed. Patients were divided into three groups according to the treatment method: anticoagulant therapy (AC group), anticoagulation plus catheter-directed thrombolysis (CDT group), and anticoagulation plus AngioJet thrombectomy plus catheter-directed thrombolysis (PCDT group). The evaluation criteria for efficacy mainly included preoperative and postoperative clinical symptoms (Villalta score), thrombus diameter, thrombus clearance rate, filter retrieval rate, filter retention time, and urokinase dosage. RESULTS: This study included 47 patients, of whom 31 were males (65.9%) and 16 females (34.1%), with a mean age of 72.05 ± 8.32 years. An Aegisy filter was used in seven patients, whereas an Illicium filter was used in forty patients. There were a total of nineteen patients in the anticoagulation-only group, with complete dissolution of the intraluminal thrombus in five patients, a residual thrombus with a maximum diameter ≤1 cm in three patients, and a residual thrombus with a maximum diameter >1 cm in eleven patients. The Villalta score was 7.16 ± 0.6 before treatment and decreased to 3.79 ± 0.59 after treatment. The thrombus diameter decreased from an average of 1.46 ± 0.2 cm before treatment to an average of 0.85 ± 0.14 cm after treatment. The retrieval rate for the filters was 42.11% (8/19), with an average dwell time of 27.4 ± 1.3 days for the filters. The CDT group consisted of 17 patients. Among whom we observed, complete dissolution of the intraluminal thrombus was observed in six patients, residual thrombus with a maximum diameter ≤1 cm in nine patients, and residual thrombus with a maximum diameter >1 cm in two patients. The Villalta score decreased from 7.53 ± 0.83 before treatment to 2.06 ± 0.39 after treatment. The thrombus diameter also decreased from 1.46 ± 0.16 cm before treatment to 0.35 ± 0.11 cm after treatment. The retrieval rate of the filters was 88.24% (15/17), and the average filter indwelling time was 19.25 ± 4.5 days. The PCDT group consisted of 11 patients. We observed complete dissolution of the intraluminal thrombus in four patients, residual thrombus with a maximum diameter ≤1 cm in six patients, and residual thrombus with a maximum diameter >1 cm in one patient. The Villalta score decreased from 7.45 ± 0.76 before treatment to 2.09 ± 0.55 after treatment. The thrombus diameter decreased from 1.50 ± 0.21 cm before treatment to 0.33 ± 0.35 cm after treatment, and the rate of filter retrieval was 90.91% (10/11). CONCLUSION: The three treatments of anticoagulation therapy, CDT, and PCDT were meaningful for preoperative and postoperative thrombolysis and symptom improvement in patients with IVCFT. The application of CDT and PCDT was superior to anticoagulation therapy, while there was no significant difference between the CDT and PCDT group. The retrieval rate of filters in the anticoagulation therapy group was the lowest, with no significant difference between the CDT and PCDT group.

Assessment of superior vena cava diameter and collapsibility index in liver transplantation: a prospective observational study.

BACKGROUND: Superior Vena Cava (SVC) diameter and collapsibility index, dynamic measures of fluid responsiveness, have been successfully utilized as echocardiographic indices for fluid responsiveness in ventilated septic patients. Whether these measurements are correlated with Central Venous Pressure (CVP) measurements in liver transplant patients is unknown. We sought to assess the correlation of maximum and minimum SVC diameter and SVC collapsibility index measurements obtained intraoperatively by Transesophageal Echocardiography (TEE) with those of simultaneously recorded CVP measurements obtained through a right atrial port of a pulmonary artery catheter. The secondary aim of the study was to assess the correlation between SVC measurements and simultaneously obtained thermodilution cardiac index measurements. METHODS: Single center prospective observational trial of patients with end stage liver disease undergoing liver transplantation in an academic tertiary care center. RESULTS: The minimum SVC exhibited a mild significant correlation with CVP as did the maximum SVC. The correlation between the SVC collapsibility index and CVP was not significantly different from zero. In our secondary analysis, the correlation between minimum SVC diameter and cardiac index was determined to be weak but non-zero as was the correlation between the maximum SVC diameter and cardiac index. The correlation between SVC collapsibility index and cardiac index was not different from zero. CONCLUSION: While statistically significant, the weak clinical correlation of intraoperative SVC measurements obtained by TEE make them unsuitable as a replacement for central venous pressure or thermodilution cardiac index measurements in liver transplant recipients.

Superior and inferior vena cava syndrome caused by a rare lung cancer: A case report.

Superior vena cava syndrome (SVCS) is commonly caused by mediastinal malignancies. Early identification through clinical signs and imaging is critical to avoid complications including cerebral and laryngeal edema, and cardiogenic shock. We present a case of large cell neuroendocrine carcinoma causing superior and inferior vena cava compression that responded well to radiotherapy and chemotherapy.

Effect of Respirophasic Displacement of the Inferior Vena Cava on Size Measurement in 2-D Ultrasound Imaging.

OBJECTIVE: Volume status assessment of a patient by ultrasound (US) imaging of the inferior vena cava (IVC) is important for the diagnosis and prognosis of various clinical conditions. In order to improve the clinical investigation of IVC, which is mainly based on unidirectional US (in M-mode), automated processing of 2-D US scans (in B-mode) has enabled tissue movement tracking on the visualized plane and can average this in various directions. However, IVC geometry outside of the visualized plane is not under control and could result in errors that have not yet been evaluated. METHODS: We used a method that integrates information from long- and short-axis IVC views (simultaneously acquired in the X-plane) to assess challenges in IVC diameter estimations using 2-D US scans in eight healthy subjects. RESULTS: Relative movements between the US probe and IVC induced the following problems when assessing IVC diameter via 2-D view: a median error (i.e., absolute difference with respect to diameter measured in the X-plane) of 17% using 2-D US scans in the long-axis view of the IVC affected by medio-lateral displacements (median: 4 mm); and a median error of 7% and 9% when measuring the IVC diameter from a short-axis view in the presence of pitch angle (median: 0.12 radians) and cranio-caudal movement (median: 15 mm), respectively. CONCLUSION: Relative movements in the IVC that are out of view of B-mode scans cannot be detected, which results in challenges in IVC diameter estimation.

Three Cases of Intracardiac Leiomyomatosis with Very Long-term Follow-up.

Uterine intravascular leiomyomatosis (IVL) with extension into the right heart is uncommon, with no more than 400 cases reported in the literature since 1907. The present study aims to report three patients with intracardiac IVL surgically treated in our institution, with long-term follow-up. Three female patients in their third to fifth decades of life, with a history of difficult hysterectomy due to extensive myomatosis, presented with symptoms of right-sided heart failure. Echocardiography and computed tomography were performed, where IVL extending from the pelvis into the right heart was observed. All three patients underwent a one-stage operation under extracorporeal circulation through a right auriculotomy and inferior vena cavotomy, accessed via a sterno-laparotomy. The tumors were extirpated without complications, with ligation of the vena cava or iliac vein. The patients at 10-, 13-, and 37-year follow-up were well and alive with mild lower extremities symptoms.