Anaesthetic Management of a Pregnant Patient with Left Atrial Myxoma and Myxoma Excision of Lower Segment Caesarean

Introduction Myxoma is the most common adult primary cardiac tumor. Embolism and intracardiac obstruction are its dangerous complications and it should be excised at the earliest. Case report A 25 years old lady in 29th week gestation was diagnosed to have a large left atrial (LA) myxoma. Echocardiography showed a large LA myxoma causing mitral inflow obstruction, impaired right ventricular function, severe pulmonary artery hypertension and normal left ventricular function. Patient was referred to an Obstetrician and gynecologist and as she was asymptomatic cardiac wise, a joint decision was made to wait until she completed 32 weeks of pregnancy and then elective lower segment caesarean section (LSCS) was performed under general anesthesia and a live male baby was delivered. Under general anesthesia and cardiopulmonary bypass, a large LA myxoma was excised the next day. Postoperatively she required prolonged inotropic and ventilatory support. She had azotemia and deranged liver functions, which were managed conservatively. Conclusion The aim of this presentation is to discuss in detail the challenges in anesthetic management of the patient with LA myxoma both for cardiac and non-cardiac surgeries. It is also discussed in detail that whether LSCS or LA myxoma excision should be performed first and the pros and cons of it.