Document Type : Case Report(s)
Authors
Preventive Cardiovascular Research Centre Kermanshah, Kermanshah University of Medical Sciences, Kermanshah, Iran
Abstract
The left atrium is the most common location of myxomas, which are benign tumors. Only a few cases of myxomas in pregnancies have been reported. Our thorough medical literature search showed only 17 reported cases in the course of pregnancy. Myxomas during pregnancy and in the preterm period constitute a serious phenomenon that can mimic an early sign of a life-threatening pathology like severe mitral stenosis. We describe a 33-year-old woman, who presented with acute dyspnea to a gynecology center and was referred to our hospital for further evaluation of pulmonary embolism. Transthoracic echocardiography showed a huge left atrial myxoma, and computed tomography scan illustrated paradoxical pulmonary embolism in the left upper lung lobe via a large patent foramen ovale. The tumor required urgent cardiac surgery. In this article, we review causes of dyspnea in pregnancy and the cardiovascular effects of myxomas in pregnancy. We also describe the pathophysiological effects of cardiopulmonary bypass on the mother, fetus, and the feto-placental system during open-heart surgery. We performed a successful surgical resection of a myxoma in a pregnant woman. Given the rarity of such cases, individual multidisciplinary assessment and management strategies are essential.
Keywords
- Pinede L, Duhaut P, Loire R. Clinical presentation of left atrial cardiac myxoma. A series of 112 consecutive cases. Medicine (Baltimore). 2001;80:159-72. PubMed PMID: 11388092.
- Whitlock R, Evans R, Lonn E, Teoh K. Giant left atrial myxoma and associated mitral valve pathology. J Cardiothorac Vasc Anesth. 2007;21:103-5. doi: 10.1053/j.jvca.2005.10.015. PubMed PMID: 17289492.
- Abbas AE, Lester SJ, Connolly H. Pregnancy and the cardiovascular system. Int J Cardiol. 2005;98:179-89. doi: 10.1016/j.ijcard.2003.10.028. PubMed PMID: 15686766.
- Veldtman GR, Connolly HM, Grogan M, Ammash NM, Warnes CA. Outcomes of pregnancy in women with tetralogy of Fallot. J Am Coll Cardiol. 2004;44:174-80. doi: 10.1016/j.jacc.2003.11.067. PubMed PMID: 15234429.
- Dodd JM, Reid K. Tocolysis for assisting delivery at caesarean section. Cochrane Database Syst Rev. 2006:CD004944. doi: 10.1002/14651858.CD004944.pub2. PubMed PMID: 17054225.
- Yaju Y, Nakayama T. Effectiveness and safety of ritodrine hydrochloride for the treatment of preterm labour: a systematic review. Pharmacoepidemiol Drug Saf. 2006;15:813-22. doi: 10.1002/pds.1317. PubMed PMID: 16981213.
- Siu SC, Sermer M, Colman JM, Alvarez AN, Mercier LA, Morton BC, et al. Prospective multicenter study of pregnancy outcomes in women with heart disease. Circulation. 2001;104:515-21. doi: 10.1161/hc3001.093437. PubMed PMID: 11479246.
- Drenthen W, Pieper PG, Roos-Hesselink JW, van Lottum WA, Voors AA, Mulder BJ, et al. Outcome of pregnancy in women with congenital heart disease: a literature review. J Am Coll Cardiol. 2007;49:2303-11. doi: 10.1016/j.jacc.2007.03.027. PubMed PMID: 17572244.
- Khairy P, Ouyang DW, Fernandes SM, Lee-Parritz A, Economy KE, Landzberg MJ. Pregnancy outcomes in women with congenital heart disease. Circulation. 2006;113:517-24. doi: 10.1161/CIRCULATIONAHA.105.589655. PubMed PMID: 16449731.
- John AS, Connolly HM, Schaff HV, Klarich K. Management of cardiac myxoma during pregnancy: a case series and review of the literature. Int J Cardiol. 2012;155:177-80. doi: 10.1016/j.ijcard.2011.05.069. PubMed PMID: 21715030.
- Ferrari E, Tozzi P, von Segesser LK. Spontaneous coronary artery dissection in a young woman: from emergency coronary artery bypass grafting to heart transplantation. Eur J Cardiothorac Surg. 2005;28:349-51. doi: 10.1016/j.ejcts.2005.04.035. PubMed PMID: 15949946.
- Dob DP, Yentis SM. Practical management of the parturient with congenital heart disease. Int J Obstet Anesth. 2006;15:137-44. doi: 10.1016/j.ijoa.2005.07.005. PubMed PMID: 16434181.
- Matsushita T, Huynh AT, Singh T, Hayes P, Armarego S, Seah PW. Mitral valve annular dilatation caused by left atrial myxoma. Heart Lung Circ. 2009;18:145-7. doi: 10.1016/j.hlc.2007.10.017. PubMed PMID: 18242131.
- Formica F, Sangalli F, Paolini G. Unusually large left atrial myxoma causing mitral valve occlusion and hiding a severe mitral regurgitation: a case report. Heart Surg Forum. 2006;9:E849-50. doi: 10.1532/HSF98.20061077. PubMed PMID: 17060039.
- Germing A, Lindstaedt M, Mugge A, Laczkovics A, Fritz M. Severity of mitral regurgitation may be underestimated in the presence of a left atrial myxoma. J Heart Valve Dis. 2006;15:830-2. PubMed PMID: 17152792.
)