Anesthetic Management of a Voluminous Left Atrial Myxoma Resection in a 19 Weeks Pregnant with Atypical Clinical Presentation

Alexandros Alexis,Jean-Luc Vandenbossche,Pierre Origer,Didier De Cannière,Olivier Germay,Jean-Pierre Hacquebard,Yota Kapessidou

doi:10.1155/2019/4181502

Alexandros Alexis, Jean-Luc Vandenbossche + Show 5 more

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https://doi.org/10.1155/2019/4181502

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Journal: Case Reports in Anesthesiology	Publication Date: Dec 12, 2019
Citations: 4	License type: CC BY 4.0

Affiliation: Université Libre de Bruxelles

Abstract

We report the case of a semi-urgent cardiac surgery, in a 19 gestation age pregnant. Despite the fact that the patient was asymptomatic, except for some palpitations, a large left auricle (LA) myxoma was fortuitously diagnosed with transthoracic echocardiography (TEE). Considering the important embolic risk, the tumor was successfully removed during cardiac surgery under cardiopulmonary bypass (CPB). Fetal bradycardia following defibrillation under stable maternal and CPB conditions was successfully managed. The postoperative period and remainder of the pregnancy was smooth and the delivery uneventful.

Highlights

Myxomas are rare benign tumors (0.5 per million population per year), that account for the 30–50% of all cardiac tumors and are most commonly located in the le atrium (>85%) [1]
If surgery cannot be delayed until fetal maturation, fetal heart rate monitoring during cardiopulmonary bypass (CPB) is recommended, when gestational age (GA) is greater than 24 weeks [4]
We report the case of a 19 weeks parturient undergoing cardiac surgery under CPB for the resection of a le atrial myxoma

Summary

Introduction

Myxomas are rare benign tumors (0.5 per million population per year), that account for the 30–50% of all cardiac tumors and are most commonly located in the le atrium (>85%) [1]. Myxoma incidence during pregnancy is extremely low, with only 51 reported cases in the literature to date [2]. Cardiac surgery requiring cardiopulmonary bypass (CPB) during pregnancy is a high-risk, challenging procedure for anesthesiologists, associated with high maternal mortality (2.9–13.3%), mostly in emergency setting, and high fetal mortality (14.3–38.5%) [3]. If surgery cannot be delayed until fetal maturation, fetal heart rate monitoring during CPB is recommended, when gestational age (GA) is greater than 24 weeks [4]. We report the case of a 19 weeks parturient undergoing cardiac surgery under CPB for the resection of a le atrial myxoma. Special attention is given to the anesthetic management of such cases, due to their complexity, as reported in the literature

Case Presentation

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