Abstract
This case report is regarding a 32 years old female with 30 weeks gestation, presented to the obstetric department first time with gestational amenorrhoea. She has history of exertional dysponea, orthopnoea and attacks of syncope on and off from last three years. On further work up, she has got left sided intra atrial mass of about 41×36 mm in size attached to the lateral wall of left atrium, protruding into left ventricle through mitral valve, during diastole causing severe obstruction. Left ventricular systolic function was normal, estimated ejection fraction of 58% and no regional wall motion abnormality. Fetal heart rate and other parameters of fetal wellbeing was assessed, they were within normal limits. Patient and her family were counseled about her critical condition. In the presence of obstetrician within the operating room, cardiac surgery was started with all essential monitoring. A successful excision of atrial mass and mitral valve repair was done with a cross clamp time of 45 minutes and total cardiopulmonary bypass time of 105 minutes. Postoperatively, patient was shifted to cardiac ICU and extubated when met the criteria of extubation and she was kept in cardiac ICU for 48 hours. In CICU, fetal cardiac activity was assessed continuously. All parameters regarding fetus were remained within normal limits and Obstetrician decided to plan for Caesarian section vs. spontaneous vaginal Delivery after four to six weeks, with regular weekly visits to labor suit. At 36th week, patient was admitted for induction of labor or possible caesarean section. The whole of the labor went uneventful and she delivered a male baby with good APGAR score. There were no postpartum complications. Histopathology of the excised mass showed a very rare intra cardiac tumor i.e. Chondrosarcoma.
Highlights
Primary cardiac tumors are rare, with an autopsy incidence ranging from 0.001% to 0.030% [1]
Chondrosarcoma is a malignant tumor of cartilaginous tissues that has been exceptionally described in the heart
The most common sarcoma is vascular in origin, angiosarcomas; a variety of bony, neurogenic, cardiogenic and soft tissue variants have been reported [7]
Summary
Primary cardiac tumors are rare, with an autopsy incidence ranging from 0.001% to 0.030% [1]. Chondrosarcoma is a malignant tumor of cartilaginous tissues that has been exceptionally described in the heart. Chondrosarcomas of the heart are very rare and the majority of them are secondary, where the primary site can be identified. Primary chondrosarcoma of the heart has not been described in WHO classification of cardiac tumors [4]. The prognosis of patients with cardiac chondrosarcoma is poor; survival is measured in weeks or months [5]. In this case report we are going to discuss the surgical excision of atrial Chondrosarcoma in a 30 weeks pregnant female. The important aspect of this case report is a malignant cardiac tumor which was operated during third trimester of pregnancy. According to some studies the mortality rates depends upon the preoperative functional class, i.e. increasing functional class proportionally increase mortality rates [6]
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