Pregnancy Myxoma of the Heart

Carole Toy^*

Department of Cardiology, University of Belfast, UK

Abstract

Objective The clinical characteristics of cardiac myxoma during pregnancy have not been sufficiently clarified, and the incidence of this condition is low. The goal of this article is to talk about the treatment options and risk factors that affect the chances of a healthy mother and child. Methods The present review includes 44 articles with 51 patients from a comprehensive search of the literature on cardiac myxoma in pregnancy. Conclusion It is critical to make a cardiac myxoma diagnosis during pregnancy. Due to the shorter operation time and non-emergency nature of the surgical intervention, surgical treatment of cardiac myxoma in pregnant patients has resulted in favorable maternal and fetal outcomes in the delivery group. Maternal and neonatal survival rates may even improve with better conditions for cardiopulmonary bypass and the timing of cardiac surgery

Keywords

Myxoma • Pregnancy • Maternal • Cardiopalmonary bypass

Introduction

Pregnancy related cardiovascular disorders have become a growing concern for both mother and child in terms of their prognoses. Due to the fact that cardiopulmonary bypass puts more fetuses in danger than mothers, cardiac surgery during pregnancy continues to be a serious issue. Among pregnant patients who had a cardiac operation, the overall fetal mortality rate was 18.6 percent. The fetal passings were evidently connected with cardiovascular medical procedure during early pregnancy as well as the utilization of cardiopulmonary bypass. Heart myxoma in pregnancy is one of the cardiovascular problems that warrant a careful resection without delay. In any case, the clinical elements of heart myxomas in the pregnant patients have not been adequately expounded, and the gamble factors influencing the maternal and feto-neonatal results remain uncertain. To feature these viewpoints, a far reaching writing audit of pregnant cardiovascular myxoma is directed [1].

Methods

Up until November 2014, publications in all languages that reported on cardiac myxoma during pregnancy were obtained from MEDLINE, Highwire Press, Google, and Yahoo! search motors, Chinese Clinical Reference Record (CMCI) and LI-LACs. The terms “pregnancy” and “cardiac myxoma” were searched. The search strategy also used the terms “left atrial,” “right atrial,” “left ventricular,” “right ventricular,” “mitral valve,” “tricuspid valve,” and “aortic valve” to find articles with cardiac myxomas [2,3].

Abbreviations, acronyms, and symbols QUOROM Quality of Reporting of Meta- Analyses and the CMCI Chinese Medical Citation Index were the primary exclusion criteria. Other types of cardiac tumors, the undetermined nature of an intracardiac mass, myxoma of the other organs of pregnant patients, fetal cardiac myxoma, and animal cardiac myxoma were also excluded. For the purposes of the statistical analyses, no pregnant patient data were included in any papers. The outcomes of literature retrieval are presented in Table 1. The patient population, demographics, diagnosis, clinical features of cardiac myxomas, associated disorders or comorbidities, cardiac surgical procedures, delivery methods, timing of cardiac myxoma and delivery, follow-up length and survival, complication and mortality of both mother and baby, etc., were meticulously extracted from the data. In the absence of larger patient populations, comparative studies, or randomized studies, this uncommon condition was only found in sporadic single-case or small-series reports. According to the Quality of Reporting of Meta-Analyses (QUOROM) recommendations, the qualitative analysis of the gathered data from the retrieved articles constituted a systematic review [5].

Prognosis

16 cases in the delivery group did not specify the mode of delivery. Twenty (76.9%) of the 26 deliveries that required a cesarean section or a vaginal delivery were event-free, four (15.4%) were complicated, and two (7.7%) died. In relation to delivery, neonatal prognoses did not differ between delivery methods, treatment options, the timing of cardiac surgery, or the sequence of cardiac myxoma. Nominal relapse investigation showed that timing of deattire, conveyance mode, careful resection of the cardiovascular myxoma, basic or complex cardiovascular medical procedure, timing of heart medical procedure, succession of cardiovascular medical procedure corresponding to conveyance what’s more, maternal intricacies were not prescient gamble factors liable for fetal results [6,7].

Discussion

Heart myxoma is uncommon in pregnant patients. The nature of the intra cardiac mass, the timing of delivery, the necessity of cardiac surgery, and the risks of subsequent treatment can all make diagnosis and treatment difficult. A cardiac myxoma may exhibit one or more of the Goodwin’s triad in its clinical manifestations. Patients might give weariness and dyspnea, which, in any case, can be confounded as asthma or typical exhaustion related with pregnancy. Echocardiography is still the most common non-invasive diagnostic method, especially for pregnant patients. Atrial thrombi may have a stalk and be mistaken for myxomas in some patients, necessitating unnecessary and potentially harmful surgery. With atrial fibrillation, dilated left atrium, mitral or tricuspid stenosis, low ejection fraction, prosthetic mitral or tricuspid valves, or spontaneous atrial contrast echoes, a left intra atrial mass can be diagnosed as thrombus. In addition, cardiovascular magnetic resonance imaging is recommended for pregnant patients in order to visualize atrial myxoma, aortic dissection, coarctation, and aortitis. Careful administration of heart myxoma is like that of the valvular issues in the pregnant patients, even with insignificantly obtrusive cardiovascular careful techniques [8].

Nevertheless, the surgical symptoms of both conditions may differ in some way. Pregnancy is never a good idea if you have rheumatic mitral stenosis-related congestive heart failure. However, despite the risk of fetal teratogenicity from X-ray manipulation, it may be curable with conventional percutaneous therapy. A 30% rate of child loss and postnatal physical or mental disabilities may result from cardiac myxoma surgical resection. It is empowering that maternal endurance rate was 100 percent in the pregnant patients with a heart myxoma, better than that of the pregnant patients with infective endocarditis. This could be attributed to the advantages of cardiopulmonary bypass, such as pulsatile flow, high perfusion pressure, and a high flow rate, which are utilized in cardiac surgery during pregnancy. In contrast, due to the infectious nature of infective endocarditis and the use of profound hypothermic circulatory arrest for the operation of acute aortic dissection, infective endocarditis and cardiac myxoma may be more dangerous to pregnant patients. The current concentrate additionally uncovered that timing of conveyance other than the conveyance mode (by barring early end of pregnancy) and time grouping of heart surgery and conveyance was firmly connected with feto-neonatal mortality. Due to the risk of teratogenesis, cardiac surgery with cardiopulmonary bypass should be avoided during the first trimester, particularly after six weeks [9, 10].

Conclusion

Heart myxoma is uncommon in pregnant patients. The cardiac myxoma is typically discovered in the second trimester and resected in the third. The most common method of delivery was a cesarean section. This patient setting’s 100% maternal survival rate is encouraging. A higher rate of fetal and neonatal mortality was strongly correlated with an early delivery. The feto neonatal survival may be improved by delaying delivery until late in pregnancy or until the fetal is mature. In a nutshell, an urgent cardiac myxoma resection is required when hemodynamic deterioration and embolic potential are present. Otherwise, cardiac surgery should be avoided during the first trimester and postponed until after delivery or until the fetal pulmonary maturation stage.

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