Obstetrics and Gynaecology Cases - Reviews Wilson et al. Obstet Gynecol Cases Rev 2017, 4:106 Volume 4 | Issue 2 DOI: 10.23937/2377-9004/1410106 ISSN: 2377-9004 Open Access Citaton: Wilson E, Gopal K, Iyer J, Tam R, Schrale R, et al. (2017) Management of Maternal Atrial Myxoma in Advanced Pregnancy: A Clinical Dilemma. Obstet Gynecol Cases Rev 4:106. doi.org/10.23937/2377- 9004/1410106 Received: May 04, 2017: Accepted: October 14, 2017: Published: October 16, 2017 Copyright: © 2017 Wilson E, et al. This is an open-access artcle distributed under the terms of the Creatve Commons Atributon License, which permits unrestricted use, distributon, and reproducton in any medium, provided the original author and source are credited. Wilson et al. Obstet Gynecol Cases Rev 2017, 4:106 • Page 1 of 3 • Management of Maternal Atrial Myxoma in Advanced Pregnancy: A Clinical Dilemma Emma Wilson 1* , Karthikeyan Gopal 2 , Jay Iyer 1 , Robert Tam 3 , Ryan Schrale 2 and Yaniv Zipori 1 ed term vaginal deliveries. Thus far she had an unevent- ful pregnancy, and her only signifcant fnding was BMI of 35 and iron defciency anemia. On admission, the patent was asymptomatc and vital signs revealed blood pressure of 135/80 mmHg, heart rate of 87 bpm, and oxygen saturaton of 98% on room air. Laboratory analysis was unremarkable, except for hemoglobin level of 98 g/L. Electrocardio- gram showed normal sinus rhythm. TTE confrmed a 4 × 1 cm mobile echo-dense mass arising from interatri- al septum (LA side), and prolapsing through the mitral valve during diastole (Figure 1a and Figure 1b). The lef ventricular ejecton fracton (67%) and valvular functon were normal. Non-stress test confrmed a reassuring fe- tal status in a cephalic presentaton. Following discus- sion between cardiologists, cardiothoracic surgeons, obstetricians and anaesthetst, consensus decision was made to perform caesarean secton frst, with a view to proceed with cardiac surgery the following day afer stabilizing the patent. She underwent an uncomplicat- ed caesarean secton with tubal ligaton under general anesthesia, combined with Transesophageal Echocardi- ography (TEE) (Figure 2), and gave birth to a male in- fant, weighing 3.670 g with Apgar scores of 8 and 9 at 1 and 5 minutes, respectvely. Hemi-sternotomy was em- ployed and 30,000 Units of IV heparin was administered prior to her heart put on Cardiopulmonary Bypass (CPB) machine. A lef atrial mass was resected from the inter- atrial septum and the defect in the septum was approx- imated with a patch. The CPB tme was 59 minutes. The *Corresponding author: Yaniv Zipori, MD, Department of Obstetrics and Gynecology, Townsville Hospital, Townsville, Queensland 4814, Australia, Tel: +61-7-44333625, Fax: +61-7-44331471, E-mail: zipori74@hotmail.com Abstract In this report, we present a challenging case of pedunculated left atrial myxoma which was initially diagnosed on Transtho- racic Echocardiography (TTE) at 39 weeks and 2 days ges- tation in a grand-multigravida woman with previous normal deliveries. She was delivered by urgent caesarean section with resection of the myxoma on the following day. She had an unremarkable recovery. Physicians should be vigilant to any new onset maternal heart murmurs during pregnancy, and have a low threshold to screen with transthoracic echo- cardiography. A multidisciplinary team approach from anesthe- tists, cardiologists, cardiothoracic surgeons and maternal-fetal medicine specialists is essential to optimize fetal and maternal outcomes. Keywords Atrial myxoma, Pregnancy, Cardiac tumour, Echocardiog- raphy 1 Department of Obstetrics and Gynecology, Townsville Hospital, Townsville, Queensland, Australia 2 Department of Cardiology, Townsville Hospital, Townsville, Queensland, Australia 3 Department of Cardiothoracic Surgery, Townsville Hospital, Townsville, Queensland, Australia CaSE REpoRT Case Report A 36-year-old indigenous female with gravida 7 para 6 was transferred at 39 weeks and 2 days’ gestaton with suspected maternal lef atrial myxoma on Transthorac- ic Echocardiography (TTE) for further management. TTE was performed to investgate her recent symptoms of dyspnoea and auscultatory fnding of grade 2 systolic murmur best heard in the mitral area. There were no additonal symptoms or signs to suggest cardiac fow obstructon or systemic embolizaton. She was other- wise a healthy individual with no previous rheumatc heart disease or family history of cardiac disease. Her past obstetric history was relevant for six uncomplicat-