Gynecological carcinosarcomas are aggressive tumors with rare occurrence and high rates of metastases. We present the case of a 49-year-old woman with vaginal bleeding and abdominal distension who was found to have a large ovarian carcinosarcoma invading the gonadal vein and inferior vena cava (IVC) and extending into right atrium (RA). She underwent gynecologic tumor resection, IVC cavotomy and en bloc resection of tumor/thrombus through the RA. Use of intraoperative transesophageal echocardiography helped assess extent and mobility of mass in the RA to guide surgical approach. This case posed unique challenges with regard to management of induction, hemodynamics and coagulopathy.