Management of right ventricular myxoma diagnosed at full-term pregnancy

The diagnosis of cardiac myxoma in a woman at term pregnancy is extremely rare. Prompt surgical removal of the tumor is generally advised because of the high risk of potentially fatal complications. On the other hand, cardiac surgery during pregnancy is a delicate procedure which carries a significantly increased maternal risk when performed at or immediately after delivery.

A previously healthy 23-year-old woman at 38 weeks' gestation was diagnosed with myxoma in the right ventricle on the basis of clinical and echocardiographic examination. The patient went into labor while awaiting urgent Cesarean section. Severe right heart failure developed which completely resolved after delivery of a healthy baby. After balancing the risks of uncontrolled uterine bleeding associated with cardiopulmonary bypass against those of thromboembolism and valvular obstruction associated with the presence of myxoma itself, emergency cardiac surgery was rejected. The tumor was successfully removed five days after Cesarean section and the patient recovered uneventfully.

Cesarean section should be done as soon as possible. Considering the increased maternal morbidity and mortality when delivery is immediately followed by cardiopulmonary bypass, urgent cardiac surgery may be more reasonable than an emergency one for a patient who is clinically stable and at low risk of thromboembolism.