Massive left atrial myxoma in pregnancy: case report

Cardiac myxomas are rarely diagnosed in pregnancy.

A 41-year-old 18+3/40 weeks’ gestation pregnant woman presented with dyspnoea and palpitations on a background of a benign pituitary microadenoma and previous tenosynovial giant cell tumour. Transthoracic echocardiogram demonstrated a 9.1 × 5.5 cm left atrial mass attached to the fossa ovalis with moderate-to-severe obstruction to flow through the mitral valve. After a multidisciplinary discussion regarding maternal and fetal risks, a decision was made to proceed with intrapartum cardiac surgery, given the evidence of mitral inflow obstruction. The mass was successfully excised, and histology confirmed a cardiac myxoma. Postoperative course was uncomplicated, and a healthy baby girl was delivered at 39+1/40 weeks’ gestation.

Diagnosis and management of myxomas can be challenging in pregnancy. Symptoms can be misinterpreted as being normal in the setting of physiological changes associated with pregnancy. Surgical excision is necessary to prevent complications, including systemic embolization and haemodynamic deterioration. However, surgery is associated with significant maternal and fetal risks. Thus, a multidisciplinary approach to management is essential.