Emergent simultaneous cesarean section and maternal cardiac surgery

Management of pregnant patients with cardiovascular disease is a challenge, and limited experiences exist to date in the literature. Particularly, valve surgery is still at high risk, with a consistent rate of preterm birth, postnatal physical or mental disabilities, and fetal mortality.

A 38-year-old woman, who was 37 weeks pregnant, was admitted to the emergency department with severe dyspnea and hypertension. A transthoracic echocardiography revealed a 4 cm mobile mass in the left atrium, attached to the interatrial septum by a stalk; the mass protruded into the mitral valve orifice causing significant left ventricular inflow obstruction and severe pulmonary hypertension. A multidisciplinary team planned an urgent cesarean with cardiac surgery team in stand-by, followed by a surgical excision of the myxoma through a minimally invasive approach. The patient had a normal recovery with no significant complications; the baby received mechanical ventilation for the first six hours of life. Both the mother and the baby were discharged home on day thirteen.

In the case described, management was challenging due to mother' acute cardiac failure associated with mitral valve stenosis, severe pulmonary hypertension and pulmonary oedema at the time of first diagnosis of a left-side myxoma. The gestational age allowed the multidisciplinary team to plan an urgent cesarean followed by the cardiac surgery procedure with measured and reasonable risks. Early and specialized multidisciplinary care in the antepartum, peripartum, and postpartum period is essential to improve cardiovascular outcomes and reduce maternal mortality while safeguarding the health of the baby.