Title: Single-stage resection of Uterine Fibroids and intravascular leiomyomatosis: A Case
Report
Version: 4 Date: 21 Aug 2024
Reviewer:  Antonio Bandala-Jacques
Reviewer's report:
Dear authors - I have received your reviewed submission, and offer the following comments
and suggestions
INTRODUCTION
A) Please spell out IVL on its first use. Its use on the abstract should not count as the first time
it is used
B) You start a sentence with :"It is a rare benign tumor", but you had been referring to uterine
fibroids in plural in previous sentences.
C) In "and the mechanism is currently unclear. ", The mechanism of what?
D) Figure 1 looks low quality. Please upload a higher quality version and fix issues, such as arrow
tails overlapping with boxes. Also please be consistent with verb tenses, as you use "Removal"
and "Disrupting". Should be either "Removing / Disrupting" or "Removal / Disruption"
CASE PRESENTATION
E) In "the First Affiliated Hospital of Guangxi Medical University due to abnormal vaginal
bleeding. " is the name of the hospital relevant?  I would change this to specify what kind of
institution that is  (E,g: An urban second-level hospital, or something similar)
F) Might be worth briefly mentioning the consultation motive for the uterine fibroids four years
ago. Also, as I mentioned in my last round of commenting, I recommend not using "four years
ago", but rather "four years before current admission" or similar
G) In "Moreover, tumors in the RA could freely float, and once the tumor falls off and blocks
the atrioventricular cavity and valves, it could cause circulatory embolism and sudden cardiac
death." This sentence implies that the tumor will fall. I would restructure to "Moreover, the
patient's tumors in the RA could freely float, which could lead to blockage of the atrioventricular
cavity and valves, circulatory embolism and sudden cardiac death".
H ) "Gynecologists believe that the recurrence rate of uterine fibroids can reach 40%, and if the
tumor recurs, it is likely to develop into IVL again". Clinical decisions were most likely made
on evidence, and not beliefs. I recommend that you restructure so that you state that as a fact
I) Same for "Physicians in cardiac surgery and intensive care unit believe that the patient's CT
and ultrasound did not indicate any other organ dysfunction."  Did the ultrasound indicate other
dysfunctions or not?
"CTs and ultrasounds indicated that no other organs were involved" or similar would be better
J) "Although pulmonary embolism, bronchitis, coronary atherosclerotic heart disease and other
diseases cannot be completely ruled out, IVL is currently the first consideration for heart failure
in patients "
I would argue most of these can be ruled out. It would be better to briefly mention alternative
diagnoses and why they were unlikely
K) After sternotomy and suspension, an ultrasound guided "19th artery catheter"
Why is this quoted?
L) In ":where she received medication to maintain circulatory stability, reduce
myocardial edema, and combat infection.", please mention what medication
M) I see you added a Table 1 at a request of another reviewers, but I believe that as it is, it does
not add much, and could be mentioned in the text instead
N) Supp Table 1 would greatly benefit from an additional column detailing very briefly if the
approach was successful.
Overall, I think the manuscript has significantly improved with the modifications made by the
authors