First-Trimester Cardiac Myxoma Diagnosed at 12 Weeks with Postmortem Validation

Area of Science:

• Cardiology
• Fetal Medicine
• Pathology

Background:

• Primary cardiac tumors are rare in fetuses, with rhabdomyomas being most common.
• Fetal cardiac myxomas are exceptionally rare, particularly with first-trimester diagnosis.

Purpose of the Study:

• To report the earliest documented case of fetal cardiac myxoma.
• To highlight the potential for rapid progression and severe hemodynamic compromise.

Main Methods:

• Fetal echocardiography at 12 weeks gestation identified a right atrial mass.
• Serial ultrasounds monitored tumor growth and fetal well-being.
• Postmortem examination and histopathology confirmed the diagnosis.

Main Results:

• A hyperechoic, pedunculated mass was diagnosed as a right atrial myxoma at 12 weeks gestation.
• Rapid tumor growth and significant hemodynamic compromise (pericardial effusion, reversed A-wave flow) were observed by 14 weeks.
• Histopathology confirmed cardiac myxoma with characteristic myxoid stroma and stellate cells.

Conclusions:

• Fetal cardiac myxomas can present early and progress rapidly, causing severe hemodynamic compromise even in the first trimester.
• Early fetal echocardiography is crucial for timely diagnosis and management.
• This case represents the earliest gestational age for diagnosis and confirmation of fetal cardiac myxoma.