Staged Cesarean and Cardiac Surgery for Recurrent Left Atrial Myxofibrosarcoma in Pregnancy

Cardiac surgery in late pregnancy requires balancing maternal rescue against fetal risk.

A 31-week pregnant woman with prior resection of a left atrial "myxoma" presented with acute heart failure caused by recurrent masses prolapsing through the mitral valve. Because the fetus was viable and maternal collapse was imminent, a 7-F, 35-mL intra-aortic balloon pump was inserted, cesarean delivery was performed, and redo open-heart surgery followed the next day. A 1,638-g male infant with Apgar scores of 7 and 8 was delivered. Two posterior left atrial tumors were resected; one involved the mitral leaflet and required mechanical mitral valve replacement. Re-review of the recurrent and original specimens showed morphology and immunophenotype consistent with myxofibrosarcoma.

Staged delivery before cardiopulmonary bypass can protect a viable fetus in hemodynamically critical maternal disease.

Pathological re-evaluation is essential when "recurrent myxoma" behaves atypically.