Abstract
ObjectiveCardiac myxoma in pregnancy is rare and the clinical characteristics of this entity have been insufficiently elucidated. This article aims to describe the treatment options and the risk factors responsible for the maternal and feto-neonatal prognoses.MethodsA comprehensive search of the literature of cardiac myxoma in pregnancy was conducted and 44 articles with 51 patients were included in the present review.ResultsTransthoracic echocardiography was the most common diagnostic tool for the diagnosis of cardiac myxoma during pregnancy. Cardiac myxoma resection was performed in 95.9% (47/49); while no surgical resection was performed in 4.1% (2/49) patients (P=0.000). More patients had an isolated cardiac myxoma resection in comparison to those with a concurrent or staged additional cardiac operation [87.2% (41/47) vs. 12.8% (6/47), P=0.000]. A voluntary termination of the pregnancy was done in 7 (13.7%) cases. In the remaining 31 (60.8%) pregnant patients, cesarean section was the most common delivery mode representing 61.3% and vaginal delivery was more common accounting for 19.4%. Cardiac surgery was performed in the first, second and third trimester in 5 (13.9%), 14 (38.9%) and 17 (47.2%) patients, respectively. No patients died. In the delivery group, 20 (76.9%) neonates were event-free survivals, 4 (15.4%) were complicated and 2 (7.7%) died. Neonatal prognoses did not differ between the delivery modes, treatment options, timing of cardiac surgery and sequence of cardiac myxoma resection in relation to delivery.ConclusionThe diagnosis of cardiac myxoma in pregnancy is important. Surgical treatment of cardiac myxoma in the pregnant patients has brought about favorable maternal and feto-neonatal outcomes in the delivery group, which might be attributable to the shorter operation duration and non-emergency nature of the surgical intervention. Proper timing of cardiac surgery and improved cardiopulmonary bypass conditions may result in even better maternal and feto-neonatal survivals.
Highlights
Cardiovascular disorders during pregnancy have become a more and more attracting issue concerning both mother and child in terms of their prognoses[1]
Publications in all languages reporting on cardiac myxoma during pregnancy until November 2014 were retrieved from MEDLINE, Highwire Press, Google and Yahoo! search engines, Chinese Medical Citation Index (CMCI) and LILACs
The timing of the pregnant patients to be symptomatic was available for 15 (29.4%) patients, with a mean duration of diseased course of cardiac myxoma of 4.0±7.2 months (28 hours-24 months; median, 1 month) (n=10)
Summary
Cardiovascular disorders during pregnancy have become a more and more attracting issue concerning both mother and child in terms of their prognoses[1]. Cardiac surgery during pregnancy remains a tough problem due to the fact that cardiopulmonary bypass jeopardizes fetuses more than mothers[2]. The overall feto-neonatal mortality was 18.6% among the pregnant patients with a cardiac operation[1]. The fetal deaths were apparently associated with cardiac surgery during early pregnancy as well as the use of cardiopulmonary bypass[3]. Cardiac myxoma in pregnancy is one of the cardiovascular disorders that warrant a surgical resection without delay[1]. The clinical features of cardiac myxomas in the pregnant patients have not been sufficiently elaborated, and the risk factors influencing the maternal and feto-neonatal outcomes remain uncertain. In order to highlight these aspects, a comprehensive literature review of pregnant cardiac myxoma is conducted
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