Management of cardiac myxoma during pregnancy: A case series and review of the literature

John, Anitha S.; Connolly, Heidi M.; Schaff, Hartzell V.; Klarich, Kyle W.

doi:10.1016/j.ijcard.2011.05.069

Cited by 23 publications

(33 citation statements)

References 18 publications

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“…However, cardiac myxoma has the associated risk of embolism especially in the hypercoagulable condition of pregnancy. Therefore, another publication suggested that a surgical excision be performed in all pregnant women [4]. In our case, this was a 28-year-old pregnant patient with a long history of left atrial myxoma without any history of embolism and she had both a very large left atrial myxoma and a significant mitral valve insufficiency which may have necessitated a more complicated operation and longer duration of surgery.…”

Section: Discussionmentioning

confidence: 86%

“…The management decision in this particular case drew on the experience of numerous specialists including a cardiologist, cardiac surgeon, obstetrician, pediatrician, and a neonatologist. The multidisciplinary team approach has a crucial role in ensuring the best outcome for both mother and child [4]. The standard operative technique for dealing with a cardiac myxoma is the median sternotomy approach which allows the removal of the mass under cardiopulmonary bypass [1].…”

Section: Introductionmentioning

confidence: 99%

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Left Atrial Myxoma in Pregnancy: Management Strategy Using Minimally Invasive Surgical Approach

Taksaudom

Traisrisilp

Kanjanavanit

2017

Case Reports in Cardiology

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This case report concerns a young woman who, during her pregnancy, suffered severe mitral regurgitation. It was discovered at the same time that she had a left atrial myxoma. During the early postpartum period she successfully underwent an anterior minithoracotomy to remove the left atrial myxoma in conjunction with repair of the mitral valve. The thoracotomy approach in this specific patient was chosen as it would give a better chance of successful mother-child bonding because the patient would be able to avoid the precautions which would have been necessary following a sternotomy, especially the limitation of her ability to hold her child during the first 4–6 weeks postoperatively.

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Section: Discussionmentioning

confidence: 86%

Section: Introductionmentioning

confidence: 99%

Left Atrial Myxoma in Pregnancy: Management Strategy Using Minimally Invasive Surgical Approach

Taksaudom

Traisrisilp

Kanjanavanit

2017

Case Reports in Cardiology

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“…Physical examination may reveal systolic or diastolic murmurs, depending on the location, size, and mobility of the myxoma. Clinical features range from asymptomatic cases to valvular obstructive manifestations, signs of systemic embolization, and various non-specific constitutional symptoms [1,2]. Pregnancy, being a hypercoagulable state, may further increase the risk of embolization.…”

Section: Discussionmentioning

confidence: 99%

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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“…Cardiac myxomas have only been reported during pregnancy in 17 previous cases [2, 3]. The majority of the published cases are sporadic with the left atrium being the most common location.…”

Section: Discussionmentioning

confidence: 99%

Cardiac Myxoma Presenting as Dyspnea after Cesarean Delivery

Wyman

Hurd

Lappen

2012

Case Reports in Medicine

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Introduction. Dyspnea during pregnancy and in the immediate postpartum or postoperative period is a relatively common symptom that can be an early sign of a life threatening condition. The differential diagnosis is broad and can represent a wide variety of underlying etiologies. Cardiac tumors are one of the rarest causes of dyspnea in a reproductive age women during the postpartum period. Case Presentation. 42-years old G7P1051 presented with acute dyspnea postoperatively after an elected uncomplicated repeat cesarean section and tubal ligation. The patient was diagnosed with a large left atrial cardiac myxoma and required urgent cardiothoracic surgery. Conclusion. The following case illustrates how a standard response to a common postpartum symptom, dyspnea, can divert and distract from less common exam findings. A careful, stepwise evaluation of symptoms and related findings will usually determine the underlying cause so that appropriate and timely treatment can be initiated.

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Management of cardiac myxoma during pregnancy: A case series and review of the literature

Cited by 23 publications

References 18 publications

Left Atrial Myxoma in Pregnancy: Management Strategy Using Minimally Invasive Surgical Approach

Left Atrial Myxoma in Pregnancy: Management Strategy Using Minimally Invasive Surgical Approach

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

Cardiac Myxoma Presenting as Dyspnea after Cesarean Delivery

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