Cardiac myxoma in pregnancy: a comprehensive review

Yuan, Shi‐Min

doi:10.5935/1678-9741.20150012

Cited by 18 publications

(33 citation statements)

References 24 publications

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“…Seven cases had early termination of pregnancy, and of the 26 reported deliveries with either caesarean section (n = 19) or vaginal delivery (n = 7), 20 (76.9%) were event-free survival, 4 (15.4%) were complicated, and 2 (7.7%) died. Neonatal outcome was not different between the modes of delivery or the timing of the cardiac surgery [6]. An earlier report from women undergoing cardiothoracic surgery during pregnancy also described the feasibility of seven cases having one-stage caesarean delivery to a healthy neonate (median gestational age 31 weeks) immediately prior to thoracotomy.…”

Section: Discussionmentioning

confidence: 83%

Management of Maternal Atrial Myxoma in Advanced Pregnancy: A Clinical Dilemma

Wilson¹,

Gopal²,

Iyer³

et al. 2017

Obstet Gynecol Cases Rev

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1ed term vaginal deliveries. Thus far she had an uneventful pregnancy, and her only significant finding was BMI of 35 and iron deficiency anemia.On admission, the patient was asymptomatic and vital signs revealed blood pressure of 135/80 mmHg, heart rate of 87 bpm, and oxygen saturation of 98% on room air. Laboratory analysis was unremarkable, except for hemoglobin level of 98 g/L. Electrocardiogram showed normal sinus rhythm. TTE confirmed a 4 × 1 cm mobile echo-dense mass arising from interatrial septum (LA side), and prolapsing through the mitral valve during diastole ( Figure 1a and Figure 1b). The left ventricular ejection fraction (67%) and valvular function were normal. Non-stress test confirmed a reassuring fetal status in a cephalic presentation. Following discussion between cardiologists, cardiothoracic surgeons, obstetricians and anaesthetist, consensus decision was made to perform caesarean section first, with a view to proceed with cardiac surgery the following day after stabilizing the patient. She underwent an uncomplicated caesarean section with tubal ligation under general anesthesia, combined with Transesophageal Echocardiography (TEE) (Figure 2), and gave birth to a male infant, weighing 3.670 g with Apgar scores of 8 and 9 at 1 and 5 minutes, respectively. Hemi-sternotomy was employed and 30,000 Units of IV heparin was administered prior to her heart put on Cardiopulmonary Bypass (CPB) machine. A left atrial mass was resected from the interatrial septum and the defect in the septum was approximated with a patch. The CPB time was 59 minutes. The *Corresponding author: Yaniv Zipori, MD, Department of Obstetrics and Gynecology, Townsville Hospital, Townsville, Queensland 4814, Australia, Tel: +61-7-44333625, Fax: +61-7-44331471, E-mail: zipori74@hotmail.com AbstractIn this report, we present a challenging case of pedunculated left atrial myxoma which was initially diagnosed on Transthoracic Echocardiography (TTE) at 39 weeks and 2 days gestation in a grand-multigravida woman with previous normal deliveries. She was delivered by urgent caesarean section with resection of the myxoma on the following day. She had an unremarkable recovery. Physicians should be vigilant to any new onset maternal heart murmurs during pregnancy, and have a low threshold to screen with transthoracic echocardiography. A multidisciplinary team approach from anesthetists, cardiologists, cardiothoracic surgeons and maternal-fetal medicine specialists is essential to optimize fetal and maternal outcomes.

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Section: Discussionmentioning

confidence: 83%

Management of Maternal Atrial Myxoma in Advanced Pregnancy: A Clinical Dilemma

Wilson¹,

Gopal²,

Iyer³

et al. 2017

Obstet Gynecol Cases Rev

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“…Myxomas usually originate from the interatrial septum. Based on a comprehensive review including all 44 relevant publications,7 surgical resection of a tumour during pregnancy is a relatively safe procedure, possibly due to the short operative time. Fetal outcomes were no different between the treatment options, timing of cardiac surgery or delivery modes, though a caesarean section was carried out in most cases.…”

Section: Discussionmentioning

confidence: 99%

“…Cardiac myxoma can be life threatening and usually requires urgent surgical removal to prevent potentially serious emboli and haemodynamic deterioration or even sudden death 6. Cardiac myxomas during pregnancy are even rarer and have been reported in only 44 previous publications involving 51 patients 7. Several physiological changes in the cardiovascular system during pregnancy can theoretically worsen the disease and threaten maternal and fetal life.…”

Section: Introductionmentioning

confidence: 99%

Huge cardiac myxoma in pregnancy

Traisrisilp¹,

Kanjanavanit

Taksaudom

et al. 2017

BMJ Case Reports

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A 28-year-old pregnant woman presented at 28 weeks of gestation. She was diagnosed to have a left atrial myxoma 2 years earlier, but was lost to follow-up. During this pregnancy, the transthoracic echocardiography showed a 9 cm mass in the left atrium obstructing mitral valve inflow, interfering with mitral valve closure, causing severe mitral regurgitation and severe pulmonary hypertension. However, there were no clinical signs of pulmonary and systemic congestion or obstruction. Based on the clinical symptoms of the patient, the echocardiographic findings and the term of her pregnancy, the patient decided to schedule for a vaginal delivery with surgical correction after delivery. She gave birth at 32 weeks of gestation. During labour, pulmonary oedema developed but was detected early and it responded to therapy. Two weeks after delivery, a right anterior thoracotomy was performed to facilitate the removal of the left atrial myxoma and repair of the mitral valve.

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“…The presentation is quite protean, ranging from asymptomatic, non-specific constitutional symptoms to various cardiovascular manifestations including embolic phenomenon. Cardiac myxoma in pregnancy or postpartum is rare; literature review published in 2015 reported only 51 cases from 44 publications [18], the female to male preponderance and similarity in symptomatology with cardiovascular dysfunction makes it an important differential diagnosis of postpartum breathlessness and heart failure.…”

Section: Discussionmentioning

confidence: 99%

Left Atrial Myxoma in a Woman with Postpartum Heart Failure: The Culprit or an Incidental Bystander

Baba¹,

Talle²,

Buba³

et al. 2018

CRCM

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Myxoma is a benign and the most frequent tumor of the heart, accounting for approximately 30% of all primary cardiac tumors. Seventy five percent of atrial myxomas are in the left atrium. We present a case of a 20-year-old house wife presenting with biventricular heart failure and chest infection five months after her last child birth. Transthoracic echocardiography showed a mobile left atrial echogenic mass measuring 4.6 × 4.0 cm attached to the interatrial septum. Left ventricular systolic function was mildly reduced (EF 48%) with mitral and tricuspid incompetence. A diagnosis of left atrial myxoma with biventricular heart failure with chest infection was made. She improved on antibiotics and treatment of heart failure, and referred to Aminu Kano Teaching Hospital for further management.

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Cardiac myxoma in pregnancy: a comprehensive review

Cited by 18 publications

References 24 publications

Management of Maternal Atrial Myxoma in Advanced Pregnancy: A Clinical Dilemma

Management of Maternal Atrial Myxoma in Advanced Pregnancy: A Clinical Dilemma

Huge cardiac myxoma in pregnancy

Left Atrial Myxoma in a Woman with Postpartum Heart Failure: The Culprit or an Incidental Bystander

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