Five-hour surgery in ‘Heart and Brain’ Pleven to remove a 40-centimeter tumor from the uterus to the heart

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A multidisciplinary team of doctors from the cardiac surgery and obstetrics and gynaecology clinics performed a unique operation to remove a 40-centimetre tumour originating from the uterus and reaching to the right ventricle of the heart. The case is extremely rare and probably unique in the country, the specialists said.

“The 72-year-old patient is from Dobrich. She came to us after having sought help many times before in other medical institutions. Initially, she was admitted to Heart and Brain in Burgas and after consultations with the obstetricians at Heart and Brain in Pleven, she was admitted to us for surgical treatment,” said Dr. Yordan Krasnaliev, Head of the Cardiac Surgery Clinic at Heart and Brain in Pleven.

Penka had non-specific cardiovascular complaints for 3 years, with her heart rate reaching 150-160 beats per minute (a normal resting heart rate for adults ranges from 60 to 100 beats per minute). Her complaints increased during the summer of this year. She consulted a cardiologist and was then found to have a tumour in the right atrium originating from the inferior vena cava. The hospital ordered further imaging studies which proved a tumour formation in the pelvis minor of genital origin.

“This is also called a large tumour thrombus, which is traced from the left ovarian vein – the vein that exits the ovary, drains into the renal vein, then into the inferior vena cava and thence into the right atrium and right ventricle. Preoperatively we performed coronarography, and no pathology was found. Once it became clear that we had a unique case of a tumor formation in the abdomen, which travels through the veins to reach the heart, we made the decision to have the patient operated on by a multidisciplinary team of cardiac surgeons and gynecologists,” explained Dr. Krasnaliev.

Thus, two days after the patient’s admission, Dr. Krasnaliev, Dr. Alexander Lyubenov – head of the Department of General and Oncological Gynaecology and the cardiac surgeons Dr. Alexander Georgiev and Dr. Nedyalko Nedyalkov entered the operating room. Initially, sternotomy was performed – access to the heart, with extracorporeal circulation, also called “heart-lung” machine. The heart was opened and freed from the tumor formation. The intervention was continued by opening the patient’s abdominal area, where doctors continued with the release of the tumor. The vein through which the growth runs was severed and it was released from its walls. After its final release, the tumor was removed from the side of the heart. It is 40 cm long. Finally, the primary uterine and left ovarian myoma was removed with the entire adjacent vein.

“I dare say that this case was a real challenge for us as doctors. We have had similar cases before, but they were mostly of tumors localized in the right kidney, through the inferior vena cava and reaching to the heart. This is the first time we have come across a tumour localised from the uterus to the heart,” Dr Krasnaliev said.

Dr. Alexander Lyubenov also describes the surgery as unique in his medical practice, “To be in a joint team with our cardiac surgeons is a dream come true for me. The case is extremely interesting as it is really quite rare. There are very few publications about similar interventions. This condition is extremely rare and life-threatening, so we had to implement the best strategy for the patient.”

From a gynaecological point of view, Dr Lyubenov highlighted one key point during the operation and that was the tracking of the entire left ovarian vein until it entered the renal vein. The complicated operation lasted nearly 5 hours, and two days after that the patient was already discharged from intensive care. Today she is feeling well and cannot hide her gratitude to the doctors:

“Thanks to the doctors from ‘Heart and Brain’ Pleven I am living a new life. I have no words to express my immense gratitude to them. Unique people, unique specialists, Bulgaria needs them,” Penka said.

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