Mixoma cardíaco na gravidez: revisão abrangente

Yuan, Shi-Min

doi:10.5935/1678-9741.20150012

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Brazilian Journal of Cardiovascular Surgery

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Sumário

REVIEW ARTICLES • Rev Bras Cir Cardiovasc 30 (3) • Jul-Sep 2015 • https://doi.org/10.5935/1678-9741.20150012 copiar

Mixoma cardíaco na gravidez: revisão abrangente

Autoria SCIMAGO INSTITUTIONS RANKINGS

Resumo

Objetivo:

Mixoma cardíaco durante a gravidez é raro e as características clínicas dessa entidade não foram suficientemente esclarecidas. Este artigo tem como objetivo descrever as opções de tratamento e os fatores de risco responsáveis pelo prognóstico materno e fetal-neonatal.

Métodos:

Foi realizada uma pesquisa abrangente na literatura sobre mixoma cardíaco durante a gravidez e 44 artigos com 51 pacientes foram incluídos na presente revisão.

Resultados:

Ecocardiografia transtorácica foi a ferramenta de diagnóstico mais comum para o diagnóstico de mixoma cardíaco durante a gravidez. Ressecção do mixoma cardíaco foi realizada em 95,9% (47/49); enquanto não foi realizada ressecção cirúrgica em 4,1% (2/49) dos pacientes (P=0,000). Mais pacientes tiveram ressecção isolada do mixoma cardíaco em comparação com aqueles com operação cardíaca concomitante ou adicional [87,2% (41/47) vs. 12,8% (6/47), P=0,000]. A interrupção voluntária da gravidez foi feita em 7 (13,7%) casos. Nas restantes 31 (60,8%) pacientes grávidas, a cesariana foi o modo de parto mais comum, representando 61,3% e parto vaginal contabilizou 19,4%. A cirurgia cardíaca foi realizada no primeiro, segundo e terceiro trimestre em 5 (13,9%), 14 (38,9%) e 17 (47,2%) pacientes, respectivamente. Nenhuma paciente morreu. No grupo de parto, 20 (76,9%) recém-nascidos sobreviveram livres de eventos, 4 (15,4%) tiveram complicações e 2 (7,7%) morreram. Os prognósticos neonatais não diferiram entre os modos de parto, opções de tratamento, tempo de cirurgia cardíaca e sequência de ressecção mixoma cardíaco em relação ao parto.

Conclusão:

O diagnóstico de mixoma cardíaco durante a gravidez é importante. Tratamento cirúrgico de mixoma cardíaco em pacientes grávidas trouxe resultados favoráveis para as mães e os neonatos no grupo de parto, o que pode ser atribuído à duração mais curta da operação e à natureza não emergencial da intervenção cirúrgica. O momento adequado da cirurgia cardíaca e melhoria das condições de circulação extracorpórea podem resultar em sobrevivência materna e do feto-neonato ainda melhor.

Descritores
Cesárea; Mixoma; Mortalidade Fetal

Abbreviations, acronyms & symbols
CMCI	Chinese Medical Citation Index
QUOROM	Quality of Reporting of Meta-Analyses

Database	Total	Irrelevant	Relevant	Inclusive (by excluding duplicate indexes)
PubMed	58	34	24	26
Google	90	34	56	11
Yahoo!	120	94	26	3
Highwire Press	662	659	3	3
Chinese Medical Citation Index (CMCI)	27	23	4	4
LILACs	2	2	0	0

Symptom		n (%)	References
Circulatory	15 (48.4)
Dyspnea, palpitation		5 (33.3)	^[ ²⁰20 Fang YM, Dean R, Figueroa R. Right atrial myxoma mimicking an atrial thrombus in the third trimester of pregnancy. J Matern Fetal Neonatal Med. 2007;20(1):77-8. ^, ²⁶26 John AS, Connolly HM, Schaff HV, Klarich K. Management of cardiac myxoma during pregnancy: a case series and review of the literature. Int J Cardiol. 2012;155(2):177-80. ^, ²⁸28 Kither HJ, Stephen G, Vause S. Atrial myxoma in early pregnancy. Arch Dis Child Fetal Neonatal Ed 2012;97:A52. doi: 10.1136/fetalneonatal-2012-301809.166 https://doi.org/10.1136/fetalneonatal-20... ^, ⁴⁷47 Trimakas AP, Maxwell KD, Berkay S, Gardner TJ, Achuff SC. Fetal Monitoring during cardiopulmonary bypass for removal of a left atrial myxoma during pregnancy. Johns Hopkins Med J. 1979;144(5):156-60. ^, ⁵⁰50 Witters I, Cannie M, Moerman P, Herijgers P, Rademakers F, Coudyzer W, et al. Fetal caudal dysgenesis after maternal cardiopulmonary bypass in Pregnancy. Ultrasound. 2007;15(2):71-2. ^]
Chest pain, dyspnea/tachypenia		4 (26.6)	^[ ¹⁰10 Arumugam CG, Raju SV, Varma S, Bhaskaran K. Anaesthetic management of a pregnant patient with left atrial myxoma and myxoma excision of lower segment caesarean. Apollo Med. 2008;5(1):71-3. ^, ¹³13 Bryukhina EV, Ishchenko LS, Lomova ES, Ulanova DS. Left atrial myxoma in a pregnant woman: clinical features, tactics. Sci Pract J Obstet Gynecol. 2014;5(9):114-6. ^, ³²32 Manfredini R, Calì G, Foresti A. Acute anterior myocardial infarction in a patient with left atrial myxoma during pregnancy. G Ital Cardiol. 1995;25(11):1419-24. ^, ³⁴34 Mercer LJ, Aisenbrey G. Atrial myxoma as a complication of tocolytic therapy. A case report. J Reprod Med. 1985;30(7):561-2. ^]
Pulmonary edema		2 (13.3)	^[ ⁹9 Agosti S, Casalino L, Bertero G, Morelloni S, Barsotti A, Brunelli C. Atrial myxoma presenting during pregnancy. G Ital Cardiol (Rome). 2010;11(6):498-500. ^, ¹⁸18 Elston JH. A case report of a myxoma or rhabdomyosarcoma of the left atrium in the third trimester of pregnancy. Nebr Med J. 1984;69(7):225-6. ^]
Dyspnea		1 (6.7)	^[ ²⁶26 John AS, Connolly HM, Schaff HV, Klarich K. Management of cardiac myxoma during pregnancy: a case series and review of the literature. Int J Cardiol. 2012;155(2):177-80. ^]
Palpitation		1 (6.7)	^[ ²⁹29 Korbel' M, Kanáliková K, Fischer V, Niznanská Z, Redecha M, Paulíková Z. Management of intracavitary left atrium tumors during pregnancy: two case reports. Zentralbl Gynakol. 2001;123(10):590-2. ^]
Hemoptysis, dyspnea and cough		1 (6.7)	^[ ²⁷27 Kanth P, Vu T, Daroowalla F. Hemoptysis in pregnancy as the first sign of left atrial myxoma. Chest. 2014;146(4_MeetingAbstracts):200A. doi:10.1378/chest.1991271 https://doi.org/10.1378/chest.1991271... ^]
Dyspnea, pulmonary edema		1 (6.7)	^[ ⁴⁰40 Prieto Macías J, Orea Tejeda A, Santiago Bravo M, Vargas Bustos MA, Castillo Razo R. Left atrial myxoma causing severe mitral valve occlusion. Arch Inst Cardiol Mex. 1989;59(6):611-4. ^]
Circulatory + constitutional	7 (22.6)
Palpitations, dyspnea, fatigue		2 (28.6)	^[ ³⁰30 Koukis I, Velissaris T, Pandian A. Left atrial myxoma associated with mitral valve pathology in pregnancy. Hellenic J Cardiol. 2013;54(2):138-42. ^, ³⁹39 Ogilvie M. 'I wanted him to have a chance to survive before me' [Accessed Aug 21, 2014]. Available at: http://www.thestar.com/life/health_wellness/2011/10/22/i_wanted_him_to_have_a_chance_to_survive_before_me.html http://www.thestar.com/life/health_welln... ^]
Cough, exhaustion		2 (28.6)	^[ ¹⁹19 Erikson J. Pregnant woman undergoes rare & risky open-heart surgery to save her baby [Accessed Aug 21, 2014]. Available at: http://thestir.cafemom.com/pregnancy/171380/pregnant_woman_undergoes_rare_risky http://thestir.cafemom.com/pregnancy/171... ^, ⁴⁶46 Stony Brook University. Open-heart surgery performed on patient 27 weeks' pregnant [Accessed Aug 21, 2014]. Available at: http://www.sciencedaily.com/releases/2014/04/140421164150.htm http://www.sciencedaily.com/releases/201... ^]
Palpitation, fatigue, weight loss		1 (14.3)	^[ ¹⁴14 Casarotto D, Bortolotti U, Russo R, Betti D, Schivazappa L, Thiene G. Surgical removal of a left atrial myxoma during pregnancy. Chest. 1979;75(3):390-2. ^]
Palpitation, dyspnea, night sweat		1 (14.3)	^[ ³³33 Mann MS, Cossham PS, Baker JL, Hurley PA. Left atrial myxoma in the second trimester of pregnancy. Case report. Br J Obstet Gynaecol. 1987;94(6):592-3. ^]
Chest pain, palpitation, cough, fever, chills		1 (14.3)	^[ ²⁴24 Hasan I, Reddy S, Burns T. Myxoma in the mix [abstract]. J Hosp Med. 2014;9(Suppl 2):443 [Accessed Aug 21, 2014]. Available at: http://www.shmabstracts.com/abstract.asp?MeetingID=800&id=110744 http://www.shmabstracts.com/abstract.asp... ^]
Embolic	4 (12.9)
Headache, memory loss		1 (25)	^[ ⁴⁹49 Wahlberg D. Peaceful Christmas welcome after open heart surgery during pregnancy. Wisconsin State J [Accessed Aug 21, 2014]. Available at: http://obgyn.wisc.edu/news/open-heart-surgery-pregnancy.aspx http://obgyn.wisc.edu/news/open-heart-su... ^]
Transient ischemic attack, weakness		1 (25)	^[ ³⁸38 Obied HY. SHA 21. Surgical removal of left atrial myxoma in a pregnant lady with recent stroke during 1st trimester. J Saudi Heart Assoc. 2010;22(2):90 [Accessed Aug 21, 2014]. Available at: http://www.journalofthesaudiheart.com/article/S1016-7315(10)00333-7/fulltext http://www.journalofthesaudiheart.com/ar... ^]
Blurred vision		1 (25)	^[ ²2 Wang H, Zhang J, Li B, Li Y, Zhang H, Wang Y, et al. Maternal and fetal outcomes in pregnant patients undergoing cardiac surgery with cardiopulmonary bypass. Zhonghua Fu Chan Ke Za Zhi. 2014;49(2):104-8. ^]
Hemiparesis, optalmoplegia		1 (25)	^[ ²⁹29 Korbel' M, Kanáliková K, Fischer V, Niznanská Z, Redecha M, Paulíková Z. Management of intracavitary left atrium tumors during pregnancy: two case reports. Zentralbl Gynakol. 2001;123(10):590-2. ^]
Circulatory + embolic	3 (9.7)
Dyspnea, orthopnea, dizziness		1 (33.3)	^[ ³⁶36 Nelson SC, Coleman L, Zakowski MI. Management and cesarean delivery in a parturient with a right atrial mass. Abstract Number: F-30 [Accessed Aug 21, 2014]. Available at: http://soap.org/display_2012_abstract.php?id=F-30 http://soap.org/display_2012_abstract.ph... ^]
Chest pain, psychomotor restlessness		1 (33.3)	^[ ¹¹11 Berberovic B, Kacila M, Hadzimehmedagic A, Berberovic E. Cardiac myxoma in diabetic pregnancy. Int J Gynaecol Obstet. 2014;125(3):281-2. ^]
Chest pain, dyspnea, palpitation, syncope, dizziness		1 (33.3)	^[ ¹⁵15 Christensen M, Tingleff J, Larsen CT, Kjøller SM. Symptoms debut from a right atrial myxoma during labor. Ugeskr Laeger. 2004;166(47):4267-8. ^]
Embolic + constitutional	1 (3.2)
Dizziness, fever		1 (100)	^[ ⁸8 Agarwal AK, Venugopalan P. Dizziness during pregnancy due to cardiac myxoma. Saudi Med J. 2004;25(6):795-7. ^]
Circulatory + embolic + constitutional	1 (3.2)
Dyspnea, dizziness, fatigue		1 (100)	^[ ⁴³43 Sindjelic R, Vlajkovic G, Djukic P. Management of right ventricular myxoma diagnosed at full-term pregnancy. Med Sci Monit. 2009;15(10):CS158-61. ^]

Associated disorder	n (%)	References
Stroke/embolic events	4 (14.8)	^[ ²2 Wang H, Zhang J, Li B, Li Y, Zhang H, Wang Y, et al. Maternal and fetal outcomes in pregnant patients undergoing cardiac surgery with cardiopulmonary bypass. Zhonghua Fu Chan Ke Za Zhi. 2014;49(2):104-8. ^, ¹⁵15 Christensen M, Tingleff J, Larsen CT, Kjøller SM. Symptoms debut from a right atrial myxoma during labor. Ugeskr Laeger. 2004;166(47):4267-8. ^, ³⁸38 Obied HY. SHA 21. Surgical removal of left atrial myxoma in a pregnant lady with recent stroke during 1st trimester. J Saudi Heart Assoc. 2010;22(2):90 [Accessed Aug 21, 2014]. Available at: http://www.journalofthesaudiheart.com/article/S1016-7315(10)00333-7/fulltext http://www.journalofthesaudiheart.com/ar... ^, ⁴⁹49 Wahlberg D. Peaceful Christmas welcome after open heart surgery during pregnancy. Wisconsin State J [Accessed Aug 21, 2014]. Available at: http://obgyn.wisc.edu/news/open-heart-surgery-pregnancy.aspx http://obgyn.wisc.edu/news/open-heart-su... ^]
Recurrent cardiac myxoma	3 (11.1)	^[ ¹²12 Bortolotti U, Scioti G, Guglielmi C, Milano A, Nardi C, Tartarini G. Recurrent myxoma of the left ventricle. Case report and review of the literature. J Cardiovasc Surg (Torino). 1999;40(2):233-5. ^, ³⁵35 Nakata S, Nakano S, Mitsuda N, Itou N, Takahashi Y, Matsuda H. Recurrent left atrial myxoma in a patient with a twin fetus pregnancy. Jpn Circ J. 1996;60(2):130-2. ^, ⁴¹41 Roldán FJ, Vargas-Barrón J, Espinola-Zavaleta N, Keirns C, Romero-Cárdenas A. Recurrent myxoma implanted in the left atrial appendage. Echocardiography. 2000;17(2):169-71. ^]
Pulmonary edema	3 (11.1)	^[ ⁹9 Agosti S, Casalino L, Bertero G, Morelloni S, Barsotti A, Brunelli C. Atrial myxoma presenting during pregnancy. G Ital Cardiol (Rome). 2010;11(6):498-500. ^, ¹⁸18 Elston JH. A case report of a myxoma or rhabdomyosarcoma of the left atrium in the third trimester of pregnancy. Nebr Med J. 1984;69(7):225-6. ^, ⁴⁰40 Prieto Macías J, Orea Tejeda A, Santiago Bravo M, Vargas Bustos MA, Castillo Razo R. Left atrial myxoma causing severe mitral valve occlusion. Arch Inst Cardiol Mex. 1989;59(6):611-4. ^]
Mitral stenosis	2 (7.4)	^[ ²⁶26 John AS, Connolly HM, Schaff HV, Klarich K. Management of cardiac myxoma during pregnancy: a case series and review of the literature. Int J Cardiol. 2012;155(2):177-80. ^, ²⁸28 Kither HJ, Stephen G, Vause S. Atrial myxoma in early pregnancy. Arch Dis Child Fetal Neonatal Ed 2012;97:A52. doi: 10.1136/fetalneonatal-2012-301809.166 https://doi.org/10.1136/fetalneonatal-20... ^]
Mitral valve prolapse	2 (7.4)	^[ ¹³13 Bryukhina EV, Ishchenko LS, Lomova ES, Ulanova DS. Left atrial myxoma in a pregnant woman: clinical features, tactics. Sci Pract J Obstet Gynecol. 2014;5(9):114-6. ^, ²⁶26 John AS, Connolly HM, Schaff HV, Klarich K. Management of cardiac myxoma during pregnancy: a case series and review of the literature. Int J Cardiol. 2012;155(2):177-80. ^]
Ventricular tachycardia/premature	2 (7.4)	^[ ²¹21 Fiorilli R, Tomasco B, Serino W, Tesler UF. Asymptomatic left ventricular myxoma in pregnancy: echocardiographic diagnosis and surgical treatment. G Ital Cardiol. 1996;26(8):887-90. ^, ⁴²42 Sejhar J, Vambera M. Diagnosis of myxoma of the left heart atrium in pregnancy using 2-dimensional sector visualization. Vnitr Lek. 1982;28(12):1186-90. ^]
Pulmonary hypertension	1 (3.7)	^[ ¹⁰10 Arumugam CG, Raju SV, Varma S, Bhaskaran K. Anaesthetic management of a pregnant patient with left atrial myxoma and myxoma excision of lower segment caesarean. Apollo Med. 2008;5(1):71-3. ^, ⁴⁷47 Trimakas AP, Maxwell KD, Berkay S, Gardner TJ, Achuff SC. Fetal Monitoring during cardiopulmonary bypass for removal of a left atrial myxoma during pregnancy. Johns Hopkins Med J. 1979;144(5):156-60. ^]
Non-ST-segment elevation myocardial infarction	1 (3.7)	^[ ²⁴24 Hasan I, Reddy S, Burns T. Myxoma in the mix [abstract]. J Hosp Med. 2014;9(Suppl 2):443 [Accessed Aug 21, 2014]. Available at: http://www.shmabstracts.com/abstract.asp?MeetingID=800&id=110744 http://www.shmabstracts.com/abstract.asp... ^]
Mitral stenosis, pulmonary hypertension	1 (3.7)	^[ ²³23 Han F, Zhao Y, Lu C. Surgery intervention of pregnancy heart disease. J Pract Obstetr Gynecol. 2010;26(3):225-8. ^]
Hodgkin’s disease	1 (3.7)	^[ ³⁴34 Mercer LJ, Aisenbrey G. Atrial myxoma as a complication of tocolytic therapy. A case report. J Reprod Med. 1985;30(7):561-2. ^]
Diabetic nephropathy, preeclampsia	1 (3.7)	^[ ¹¹11 Berberovic B, Kacila M, Hadzimehmedagic A, Berberovic E. Cardiac myxoma in diabetic pregnancy. Int J Gynaecol Obstet. 2014;125(3):281-2. ^]
Right adrenalectomy for Cushing’s syndrome	1 (3.7)	^[ ³²32 Manfredini R, Calì G, Foresti A. Acute anterior myocardial infarction in a patient with left atrial myxoma during pregnancy. G Ital Cardiol. 1995;25(11):1419-24. ^]
Hyperemesis, vascular access	1 (3.7)	^[ ²⁰20 Fang YM, Dean R, Figueroa R. Right atrial myxoma mimicking an atrial thrombus in the third trimester of pregnancy. J Matern Fetal Neonatal Med. 2007;20(1):77-8. ^]
Hemodynamic deterioration	1 (3.7)	^[ ⁴³43 Sindjelic R, Vlajkovic G, Djukic P. Management of right ventricular myxoma diagnosed at full-term pregnancy. Med Sci Monit. 2009;15(10):CS158-61. ^]
Congestive heart failure, pulmonary hypertension	1 (3.7)	^[ ¹⁴14 Casarotto D, Bortolotti U, Russo R, Betti D, Schivazappa L, Thiene G. Surgical removal of a left atrial myxoma during pregnancy. Chest. 1979;75(3):390-2. ^]
Brain sarcoma	1 (3.7)	^[ ²⁹29 Korbel' M, Kanáliková K, Fischer V, Niznanská Z, Redecha M, Paulíková Z. Management of intracavitary left atrium tumors during pregnancy: two case reports. Zentralbl Gynakol. 2001;123(10):590-2. ^]

Delivery mode	Total	Event-free	Complicated	Died
Cesarean section, n (%)	19 (100)	15 (78.9) ^[²2 Wang H, Zhang J, Li B, Li Y, Zhang H, Wang Y, et al. Maternal and fetal outcomes in pregnant patients undergoing cardiac surgery with cardiopulmonary bypass. Zhonghua Fu Chan Ke Za Zhi. 2014;49(2):104-8.^,¹⁰10 Arumugam CG, Raju SV, Varma S, Bhaskaran K. Anaesthetic management of a pregnant patient with left atrial myxoma and myxoma excision of lower segment caesarean. Apollo Med. 2008;5(1):71-3.^,¹⁶16 Collins N. Woman and baby saved after emergency surgery[Accessed Aug 8, 2014]. Available at: http://www.telegraph.co.uk/health/healthnews/8975647/Woman-and-baby-saved-after-emergency-surgery.html http://www.telegraph.co.uk/health/health... ^,²⁰20 Fang YM, Dean R, Figueroa R. Right atrial myxoma mimicking an atrial thrombus in the third trimester of pregnancy. J Matern Fetal Neonatal Med. 2007;20(1):77-8.^,²¹21 Fiorilli R, Tomasco B, Serino W, Tesler UF. Asymptomatic left ventricular myxoma in pregnancy: echocardiographic diagnosis and surgical treatment. G Ital Cardiol. 1996;26(8):887-90.^,²⁸28 Kither HJ, Stephen G, Vause S. Atrial myxoma in early pregnancy. Arch Dis Child Fetal Neonatal Ed 2012;97:A52. doi: 10.1136/fetalneonatal-2012-301809.166 https://doi.org/10.1136/fetalneonatal-20... 29 Korbel' M, Kanáliková K, Fischer V, Niznanská Z, Redecha M, Paulíková Z. Management of intracavitary left atrium tumors during pregnancy: two case reports. Zentralbl Gynakol. 2001;123(10):590-2.^-³⁰30 Koukis I, Velissaris T, Pandian A. Left atrial myxoma associated with mitral valve pathology in pregnancy. Hellenic J Cardiol. 2013;54(2):138-42.^,³⁵35 Nakata S, Nakano S, Mitsuda N, Itou N, Takahashi Y, Matsuda H. Recurrent left atrial myxoma in a patient with a twin fetus pregnancy. Jpn Circ J. 1996;60(2):130-2.^,³⁶36 Nelson SC, Coleman L, Zakowski MI. Management and cesarean delivery in a parturient with a right atrial mass. Abstract Number: F-30 [Accessed Aug 21, 2014]. Available at: http://soap.org/display_2012_abstract.php?id=F-30 http://soap.org/display_2012_abstract.ph... ^,³⁹39 Ogilvie M. 'I wanted him to have a chance to survive before me' [Accessed Aug 21, 2014]. Available at: http://www.thestar.com/life/health_wellness/2011/10/22/i_wanted_him_to_have_a_chance_to_survive_before_me.html http://www.thestar.com/life/health_welln... ^,⁴⁰40 Prieto Macías J, Orea Tejeda A, Santiago Bravo M, Vargas Bustos MA, Castillo Razo R. Left atrial myxoma causing severe mitral valve occlusion. Arch Inst Cardiol Mex. 1989;59(6):611-4.^,⁴⁵45 Smith A. Asymptomatic atrial myxoma during pregnancy. RCOG World Congress 2013 Liverpool UK, 24-26 June 2013 [Accessed Aug 21, 2014]. Available at: http://www.epostersonline.com/rcog2013/?q=node/409 http://www.epostersonline.com/rcog2013/?... ^,⁴⁶46 Stony Brook University. Open-heart surgery performed on patient 27 weeks' pregnant [Accessed Aug 21, 2014]. Available at: http://www.sciencedaily.com/releases/2014/04/140421164150.htm http://www.sciencedaily.com/releases/201... ^]	2 (10.5) ^[¹³13 Bryukhina EV, Ishchenko LS, Lomova ES, Ulanova DS. Left atrial myxoma in a pregnant woman: clinical features, tactics. Sci Pract J Obstet Gynecol. 2014;5(9):114-6.^,²⁹29 Korbel' M, Kanáliková K, Fischer V, Niznanská Z, Redecha M, Paulíková Z. Management of intracavitary left atrium tumors during pregnancy: two case reports. Zentralbl Gynakol. 2001;123(10):590-2.^]	2 (10.5) ^[¹¹11 Berberovic B, Kacila M, Hadzimehmedagic A, Berberovic E. Cardiac myxoma in diabetic pregnancy. Int J Gynaecol Obstet. 2014;125(3):281-2.^,³²32 Manfredini R, Calì G, Foresti A. Acute anterior myocardial infarction in a patient with left atrial myxoma during pregnancy. G Ital Cardiol. 1995;25(11):1419-24.^]
Vaginal delivery, n (%)	6 (100)	4 (66.7) ^[⁵5 John AS, Gurley F, Schaff HV, Warnes CA, Phillips SD, Arendt KW, et al. Cardiopulmonary bypass during pregnancy. Ann Thorac Surg. 2011;91(4):1191-6.^,²⁵25 Hosseini S, Yaghoubi A, Khamoushi AJ, Raissi K, Kashfi F, Sadeghpour A, et al. Open heart surgery in pregnant women. Iran Heart J. 2004;5(4):34-9.^]	2 (33.3) ^[⁵5 John AS, Gurley F, Schaff HV, Warnes CA, Phillips SD, Arendt KW, et al. Cardiopulmonary bypass during pregnancy. Ann Thorac Surg. 2011;91(4):1191-6.^]	0 (0)
Device delivery, n (%)	1 (100)	1 (100) ^[³³33 Mann MS, Cossham PS, Baker JL, Hurley PA. Left atrial myxoma in the second trimester of pregnancy. Case report. Br J Obstet Gynaecol. 1987;94(6):592-3.^]	0 (0)	0 (0)
χ²	29.9	0.7	2.0	0.8
P value	0.000	0.705	0.366	0.671

Treatment	Total	Event-free	Complicated	Died
Surgical	39 (100)	31 (79.5)	5 (12.8)	3 (7.7)
Isolated myxoma resection	34 (100)	27 (79.4) ^[²2 Wang H, Zhang J, Li B, Li Y, Zhang H, Wang Y, et al. Maternal and fetal outcomes in pregnant patients undergoing cardiac surgery with cardiopulmonary bypass. Zhonghua Fu Chan Ke Za Zhi. 2014;49(2):104-8.^,⁸8 Agarwal AK, Venugopalan P. Dizziness during pregnancy due to cardiac myxoma. Saudi Med J. 2004;25(6):795-7.^,¹⁰10 Arumugam CG, Raju SV, Varma S, Bhaskaran K. Anaesthetic management of a pregnant patient with left atrial myxoma and myxoma excision of lower segment caesarean. Apollo Med. 2008;5(1):71-3.^,¹⁴14 Casarotto D, Bortolotti U, Russo R, Betti D, Schivazappa L, Thiene G. Surgical removal of a left atrial myxoma during pregnancy. Chest. 1979;75(3):390-2.^,¹⁶16 Collins N. Woman and baby saved after emergency surgery[Accessed Aug 8, 2014]. Available at: http://www.telegraph.co.uk/health/healthnews/8975647/Woman-and-baby-saved-after-emergency-surgery.html http://www.telegraph.co.uk/health/health... 17 Donahoo JS, Weiss JL, Gardner TJ, Fortuin NJ, Brawley RK. Current management of atrial myxoma with emphasis on a new diagnostic technique. Ann Surg. 1979;189(6):763-8. 18 Elston JH. A case report of a myxoma or rhabdomyosarcoma of the left atrium in the third trimester of pregnancy. Nebr Med J. 1984;69(7):225-6. 19 Erikson J. Pregnant woman undergoes rare & risky open-heart surgery to save her baby [Accessed Aug 21, 2014]. Available at: http://thestir.cafemom.com/pregnancy/171380/pregnant_woman_undergoes_rare_risky http://thestir.cafemom.com/pregnancy/171... 20 Fang YM, Dean R, Figueroa R. Right atrial myxoma mimicking an atrial thrombus in the third trimester of pregnancy. J Matern Fetal Neonatal Med. 2007;20(1):77-8.^-²¹21 Fiorilli R, Tomasco B, Serino W, Tesler UF. Asymptomatic left ventricular myxoma in pregnancy: echocardiographic diagnosis and surgical treatment. G Ital Cardiol. 1996;26(8):887-90.^,²⁴24 Hasan I, Reddy S, Burns T. Myxoma in the mix [abstract]. J Hosp Med. 2014;9(Suppl 2):443 [Accessed Aug 21, 2014]. Available at: http://www.shmabstracts.com/abstract.asp?MeetingID=800&id=110744 http://www.shmabstracts.com/abstract.asp... ²⁷27 Kanth P, Vu T, Daroowalla F. Hemoptysis in pregnancy as the first sign of left atrial myxoma. Chest. 2014;146(4_MeetingAbstracts):200A. doi:10.1378/chest.1991271 https://doi.org/10.1378/chest.1991271... ^,²⁹29 Korbel' M, Kanáliková K, Fischer V, Niznanská Z, Redecha M, Paulíková Z. Management of intracavitary left atrium tumors during pregnancy: two case reports. Zentralbl Gynakol. 2001;123(10):590-2.^,³¹31 Mahoori A, Farasatkish R, Aghdaie N, Faritus Z, Mollasadeghi G, Kashfi F. Outcome of anesthesia and open heart surgery in pregnant patients. J Teh Univ Heart Ctr. 2007;2(1):21-4.^,³⁴34 Mercer LJ, Aisenbrey G. Atrial myxoma as a complication of tocolytic therapy. A case report. J Reprod Med. 1985;30(7):561-2.^,³⁵35 Nakata S, Nakano S, Mitsuda N, Itou N, Takahashi Y, Matsuda H. Recurrent left atrial myxoma in a patient with a twin fetus pregnancy. Jpn Circ J. 1996;60(2):130-2.^,³⁷37 No authors listed. Interesting cases [Accessed Aug 21, 2014]. Available at: http://www.heartsurgery.in/interesting_cases.htm http://www.heartsurgery.in/interesting_c... 38 Obied HY. SHA 21. Surgical removal of left atrial myxoma in a pregnant lady with recent stroke during 1st trimester. J Saudi Heart Assoc. 2010;22(2):90 [Accessed Aug 21, 2014]. Available at: http://www.journalofthesaudiheart.com/article/S1016-7315(10)00333-7/fulltext http://www.journalofthesaudiheart.com/ar... ^-³⁹39 Ogilvie M. 'I wanted him to have a chance to survive before me' [Accessed Aug 21, 2014]. Available at: http://www.thestar.com/life/health_wellness/2011/10/22/i_wanted_him_to_have_a_chance_to_survive_before_me.html http://www.thestar.com/life/health_welln... ^,⁴⁴44 Siu SC, Sermer M, Harrison DA, Grigoriadis E, Liu G, Sorensen S, et al. Risk and predictors for pregnancy-related complications in women with heart disease. Circulation. 1997;96(9):2789-94. 45 Smith A. Asymptomatic atrial myxoma during pregnancy. RCOG World Congress 2013 Liverpool UK, 24-26 June 2013 [Accessed Aug 21, 2014]. Available at: http://www.epostersonline.com/rcog2013/?q=node/409 http://www.epostersonline.com/rcog2013/?... ^-⁴⁶46 Stony Brook University. Open-heart surgery performed on patient 27 weeks' pregnant [Accessed Aug 21, 2014]. Available at: http://www.sciencedaily.com/releases/2014/04/140421164150.htm http://www.sciencedaily.com/releases/201... ^,⁴⁹49 Wahlberg D. Peaceful Christmas welcome after open heart surgery during pregnancy. Wisconsin State J [Accessed Aug 21, 2014]. Available at: http://obgyn.wisc.edu/news/open-heart-surgery-pregnancy.aspx http://obgyn.wisc.edu/news/open-heart-su... ^]	4 (11.8) ^[¹³13 Bryukhina EV, Ishchenko LS, Lomova ES, Ulanova DS. Left atrial myxoma in a pregnant woman: clinical features, tactics. Sci Pract J Obstet Gynecol. 2014;5(9):114-6.^,²⁶26 John AS, Connolly HM, Schaff HV, Klarich K. Management of cardiac myxoma during pregnancy: a case series and review of the literature. Int J Cardiol. 2012;155(2):177-80.^,³³33 Mann MS, Cossham PS, Baker JL, Hurley PA. Left atrial myxoma in the second trimester of pregnancy. Case report. Br J Obstet Gynaecol. 1987;94(6):592-3.^,⁴⁸48 Tretina M, Hrdlicka M, Ondrásek J, Nemec P, Orban M. Cardiac tumor in a pregnant patient. Vnitr Lek. 2010;56(1):79-81.^]	3 (8.8) ^[¹¹11 Berberovic B, Kacila M, Hadzimehmedagic A, Berberovic E. Cardiac myxoma in diabetic pregnancy. Int J Gynaecol Obstet. 2014;125(3):281-2.^,¹²12 Bortolotti U, Scioti G, Guglielmi C, Milano A, Nardi C, Tartarini G. Recurrent myxoma of the left ventricle. Case report and review of the literature. J Cardiovasc Surg (Torino). 1999;40(2):233-5.^,³²32 Manfredini R, Calì G, Foresti A. Acute anterior myocardial infarction in a patient with left atrial myxoma during pregnancy. G Ital Cardiol. 1995;25(11):1419-24.^]
Myxoma resection with concurrent or staged additional cardiac surgery	5 (100)	4 (80) ^[²⁸28 Kither HJ, Stephen G, Vause S. Atrial myxoma in early pregnancy. Arch Dis Child Fetal Neonatal Ed 2012;97:A52. doi: 10.1136/fetalneonatal-2012-301809.166 https://doi.org/10.1136/fetalneonatal-20... ^,³⁰30 Koukis I, Velissaris T, Pandian A. Left atrial myxoma associated with mitral valve pathology in pregnancy. Hellenic J Cardiol. 2013;54(2):138-42.^,⁴⁰40 Prieto Macías J, Orea Tejeda A, Santiago Bravo M, Vargas Bustos MA, Castillo Razo R. Left atrial myxoma causing severe mitral valve occlusion. Arch Inst Cardiol Mex. 1989;59(6):611-4.^,⁴⁷47 Trimakas AP, Maxwell KD, Berkay S, Gardner TJ, Achuff SC. Fetal Monitoring during cardiopulmonary bypass for removal of a left atrial myxoma during pregnancy. Johns Hopkins Med J. 1979;144(5):156-60.^]	1 (20) ^[²⁹29 Korbel' M, Kanáliková K, Fischer V, Niznanská Z, Redecha M, Paulíková Z. Management of intracavitary left atrium tumors during pregnancy: two case reports. Zentralbl Gynakol. 2001;123(10):590-2.^]	0 (0)
Conservative	2 (100)	2 (100) ^[³⁶36 Nelson SC, Coleman L, Zakowski MI. Management and cesarean delivery in a parturient with a right atrial mass. Abstract Number: F-30 [Accessed Aug 21, 2014]. Available at: http://soap.org/display_2012_abstract.php?id=F-30 http://soap.org/display_2012_abstract.ph... ^,⁴¹41 Roldán FJ, Vargas-Barrón J, Espinola-Zavaleta N, Keirns C, Romero-Cárdenas A. Recurrent myxoma implanted in the left atrial appendage. Echocardiography. 2000;17(2):169-71.^]	0 (0)	0 (0)
P value (surgical vs.conservative)	0.000	0.475	0.589	0.684
P value (myxoma resection vs. myxoma resection with concurrent or staged additional cardiac surgery)	0.000	0.976	0.607	0.489

Timing of cardiac surgery	Total	Event-free	Complicated	Died
1^st trimester	2 (100)	2 (100) ^[²⁴24 Hasan I, Reddy S, Burns T. Myxoma in the mix [abstract]. J Hosp Med. 2014;9(Suppl 2):443 [Accessed Aug 21, 2014]. Available at: http://www.shmabstracts.com/abstract.asp?MeetingID=800&id=110744 http://www.shmabstracts.com/abstract.asp... ^,³⁸38 Obied HY. SHA 21. Surgical removal of left atrial myxoma in a pregnant lady with recent stroke during 1st trimester. J Saudi Heart Assoc. 2010;22(2):90 [Accessed Aug 21, 2014]. Available at: http://www.journalofthesaudiheart.com/article/S1016-7315(10)00333-7/fulltext http://www.journalofthesaudiheart.com/ar... ^]	0 (0)	0 (0)
2^nd trimester	12 (100)	8 (66.7) ^[⁸8 Agarwal AK, Venugopalan P. Dizziness during pregnancy due to cardiac myxoma. Saudi Med J. 2004;25(6):795-7.^,¹⁴14 Casarotto D, Bortolotti U, Russo R, Betti D, Schivazappa L, Thiene G. Surgical removal of a left atrial myxoma during pregnancy. Chest. 1979;75(3):390-2.^,¹⁷17 Donahoo JS, Weiss JL, Gardner TJ, Fortuin NJ, Brawley RK. Current management of atrial myxoma with emphasis on a new diagnostic technique. Ann Surg. 1979;189(6):763-8.^,¹⁹19 Erikson J. Pregnant woman undergoes rare & risky open-heart surgery to save her baby [Accessed Aug 21, 2014]. Available at: http://thestir.cafemom.com/pregnancy/171380/pregnant_woman_undergoes_rare_risky http://thestir.cafemom.com/pregnancy/171... ^,³⁰30 Koukis I, Velissaris T, Pandian A. Left atrial myxoma associated with mitral valve pathology in pregnancy. Hellenic J Cardiol. 2013;54(2):138-42.^,³⁹39 Ogilvie M. 'I wanted him to have a chance to survive before me' [Accessed Aug 21, 2014]. Available at: http://www.thestar.com/life/health_wellness/2011/10/22/i_wanted_him_to_have_a_chance_to_survive_before_me.html http://www.thestar.com/life/health_welln... ^,⁴⁰40 Prieto Macías J, Orea Tejeda A, Santiago Bravo M, Vargas Bustos MA, Castillo Razo R. Left atrial myxoma causing severe mitral valve occlusion. Arch Inst Cardiol Mex. 1989;59(6):611-4.^,⁴⁶46 Stony Brook University. Open-heart surgery performed on patient 27 weeks' pregnant [Accessed Aug 21, 2014]. Available at: http://www.sciencedaily.com/releases/2014/04/140421164150.htm http://www.sciencedaily.com/releases/201... ^]	4 (33.3) ^[²⁶26 John AS, Connolly HM, Schaff HV, Klarich K. Management of cardiac myxoma during pregnancy: a case series and review of the literature. Int J Cardiol. 2012;155(2):177-80.^,²⁹29 Korbel' M, Kanáliková K, Fischer V, Niznanská Z, Redecha M, Paulíková Z. Management of intracavitary left atrium tumors during pregnancy: two case reports. Zentralbl Gynakol. 2001;123(10):590-2.^,³³33 Mann MS, Cossham PS, Baker JL, Hurley PA. Left atrial myxoma in the second trimester of pregnancy. Case report. Br J Obstet Gynaecol. 1987;94(6):592-3.^,⁴⁸48 Tretina M, Hrdlicka M, Ondrásek J, Nemec P, Orban M. Cardiac tumor in a pregnant patient. Vnitr Lek. 2010;56(1):79-81.^]	0 (0)
3^rd trimester	16 (100)	13 (81.3) ^[²2 Wang H, Zhang J, Li B, Li Y, Zhang H, Wang Y, et al. Maternal and fetal outcomes in pregnant patients undergoing cardiac surgery with cardiopulmonary bypass. Zhonghua Fu Chan Ke Za Zhi. 2014;49(2):104-8.^,¹⁰10 Arumugam CG, Raju SV, Varma S, Bhaskaran K. Anaesthetic management of a pregnant patient with left atrial myxoma and myxoma excision of lower segment caesarean. Apollo Med. 2008;5(1):71-3.^,¹⁶16 Collins N. Woman and baby saved after emergency surgery[Accessed Aug 8, 2014]. Available at: http://www.telegraph.co.uk/health/healthnews/8975647/Woman-and-baby-saved-after-emergency-surgery.html http://www.telegraph.co.uk/health/health... ^,²⁰20 Fang YM, Dean R, Figueroa R. Right atrial myxoma mimicking an atrial thrombus in the third trimester of pregnancy. J Matern Fetal Neonatal Med. 2007;20(1):77-8.^,²¹21 Fiorilli R, Tomasco B, Serino W, Tesler UF. Asymptomatic left ventricular myxoma in pregnancy: echocardiographic diagnosis and surgical treatment. G Ital Cardiol. 1996;26(8):887-90.^,²⁶26 John AS, Connolly HM, Schaff HV, Klarich K. Management of cardiac myxoma during pregnancy: a case series and review of the literature. Int J Cardiol. 2012;155(2):177-80.^,²⁷27 Kanth P, Vu T, Daroowalla F. Hemoptysis in pregnancy as the first sign of left atrial myxoma. Chest. 2014;146(4_MeetingAbstracts):200A. doi:10.1378/chest.1991271 https://doi.org/10.1378/chest.1991271... ^,²⁹29 Korbel' M, Kanáliková K, Fischer V, Niznanská Z, Redecha M, Paulíková Z. Management of intracavitary left atrium tumors during pregnancy: two case reports. Zentralbl Gynakol. 2001;123(10):590-2.^,³⁴34 Mercer LJ, Aisenbrey G. Atrial myxoma as a complication of tocolytic therapy. A case report. J Reprod Med. 1985;30(7):561-2.^,³⁵35 Nakata S, Nakano S, Mitsuda N, Itou N, Takahashi Y, Matsuda H. Recurrent left atrial myxoma in a patient with a twin fetus pregnancy. Jpn Circ J. 1996;60(2):130-2.^,⁴³43 Sindjelic R, Vlajkovic G, Djukic P. Management of right ventricular myxoma diagnosed at full-term pregnancy. Med Sci Monit. 2009;15(10):CS158-61.^,⁴⁵45 Smith A. Asymptomatic atrial myxoma during pregnancy. RCOG World Congress 2013 Liverpool UK, 24-26 June 2013 [Accessed Aug 21, 2014]. Available at: http://www.epostersonline.com/rcog2013/?q=node/409 http://www.epostersonline.com/rcog2013/?... ^,⁴⁹49 Wahlberg D. Peaceful Christmas welcome after open heart surgery during pregnancy. Wisconsin State J [Accessed Aug 21, 2014]. Available at: http://obgyn.wisc.edu/news/open-heart-surgery-pregnancy.aspx http://obgyn.wisc.edu/news/open-heart-su... ^]	1 (6.3) ^[¹³13 Bryukhina EV, Ishchenko LS, Lomova ES, Ulanova DS. Left atrial myxoma in a pregnant woman: clinical features, tactics. Sci Pract J Obstet Gynecol. 2014;5(9):114-6.^]	2 (12.5) ^[¹¹11 Berberovic B, Kacila M, Hadzimehmedagic A, Berberovic E. Cardiac myxoma in diabetic pregnancy. Int J Gynaecol Obstet. 2014;125(3):281-2.^,³²32 Manfredini R, Calì G, Foresti A. Acute anterior myocardial infarction in a patient with left atrial myxoma during pregnancy. G Ital Cardiol. 1995;25(11):1419-24.^]
χ²	15.6	1.5	4.1	1.9
P value	0.000	0.480	0.132	0.392

Sequence of cardiac myxoma resection	Total	Event-free	Complicated	Died
Before delivery	18 (100)	15 (83.3) ^[⁸8 Agarwal AK, Venugopalan P. Dizziness during pregnancy due to cardiac myxoma. Saudi Med J. 2004;25(6):795-7.^,¹⁴14 Casarotto D, Bortolotti U, Russo R, Betti D, Schivazappa L, Thiene G. Surgical removal of a left atrial myxoma during pregnancy. Chest. 1979;75(3):390-2.^,¹⁷17 Donahoo JS, Weiss JL, Gardner TJ, Fortuin NJ, Brawley RK. Current management of atrial myxoma with emphasis on a new diagnostic technique. Ann Surg. 1979;189(6):763-8.^,¹⁹19 Erikson J. Pregnant woman undergoes rare & risky open-heart surgery to save her baby [Accessed Aug 21, 2014]. Available at: http://thestir.cafemom.com/pregnancy/171380/pregnant_woman_undergoes_rare_risky http://thestir.cafemom.com/pregnancy/171... ^,²⁴24 Hasan I, Reddy S, Burns T. Myxoma in the mix [abstract]. J Hosp Med. 2014;9(Suppl 2):443 [Accessed Aug 21, 2014]. Available at: http://www.shmabstracts.com/abstract.asp?MeetingID=800&id=110744 http://www.shmabstracts.com/abstract.asp... ^,²⁶26 John AS, Connolly HM, Schaff HV, Klarich K. Management of cardiac myxoma during pregnancy: a case series and review of the literature. Int J Cardiol. 2012;155(2):177-80. 27 Kanth P, Vu T, Daroowalla F. Hemoptysis in pregnancy as the first sign of left atrial myxoma. Chest. 2014;146(4_MeetingAbstracts):200A. doi:10.1378/chest.1991271 https://doi.org/10.1378/chest.1991271... ^-²⁸28 Kither HJ, Stephen G, Vause S. Atrial myxoma in early pregnancy. Arch Dis Child Fetal Neonatal Ed 2012;97:A52. doi: 10.1136/fetalneonatal-2012-301809.166 https://doi.org/10.1136/fetalneonatal-20... ^,³⁰30 Koukis I, Velissaris T, Pandian A. Left atrial myxoma associated with mitral valve pathology in pregnancy. Hellenic J Cardiol. 2013;54(2):138-42.^,³⁴34 Mercer LJ, Aisenbrey G. Atrial myxoma as a complication of tocolytic therapy. A case report. J Reprod Med. 1985;30(7):561-2.^,³⁸38 Obied HY. SHA 21. Surgical removal of left atrial myxoma in a pregnant lady with recent stroke during 1st trimester. J Saudi Heart Assoc. 2010;22(2):90 [Accessed Aug 21, 2014]. Available at: http://www.journalofthesaudiheart.com/article/S1016-7315(10)00333-7/fulltext http://www.journalofthesaudiheart.com/ar... ^,⁴⁰40 Prieto Macías J, Orea Tejeda A, Santiago Bravo M, Vargas Bustos MA, Castillo Razo R. Left atrial myxoma causing severe mitral valve occlusion. Arch Inst Cardiol Mex. 1989;59(6):611-4.^,⁴⁶46 Stony Brook University. Open-heart surgery performed on patient 27 weeks' pregnant [Accessed Aug 21, 2014]. Available at: http://www.sciencedaily.com/releases/2014/04/140421164150.htm http://www.sciencedaily.com/releases/201... ^,⁴⁷47 Trimakas AP, Maxwell KD, Berkay S, Gardner TJ, Achuff SC. Fetal Monitoring during cardiopulmonary bypass for removal of a left atrial myxoma during pregnancy. Johns Hopkins Med J. 1979;144(5):156-60.^,⁴⁹49 Wahlberg D. Peaceful Christmas welcome after open heart surgery during pregnancy. Wisconsin State J [Accessed Aug 21, 2014]. Available at: http://obgyn.wisc.edu/news/open-heart-surgery-pregnancy.aspx http://obgyn.wisc.edu/news/open-heart-su... ^]	3 (16.7) ^[²⁶26 John AS, Connolly HM, Schaff HV, Klarich K. Management of cardiac myxoma during pregnancy: a case series and review of the literature. Int J Cardiol. 2012;155(2):177-80.^,²⁹29 Korbel' M, Kanáliková K, Fischer V, Niznanská Z, Redecha M, Paulíková Z. Management of intracavitary left atrium tumors during pregnancy: two case reports. Zentralbl Gynakol. 2001;123(10):590-2.^,³³33 Mann MS, Cossham PS, Baker JL, Hurley PA. Left atrial myxoma in the second trimester of pregnancy. Case report. Br J Obstet Gynaecol. 1987;94(6):592-3.^]	0 (0)
After delivery	12 (100)	8 (66.7) ^[¹⁶16 Collins N. Woman and baby saved after emergency surgery[Accessed Aug 8, 2014]. Available at: http://www.telegraph.co.uk/health/healthnews/8975647/Woman-and-baby-saved-after-emergency-surgery.html http://www.telegraph.co.uk/health/health... ^,¹⁸18 Elston JH. A case report of a myxoma or rhabdomyosarcoma of the left atrium in the third trimester of pregnancy. Nebr Med J. 1984;69(7):225-6.^,²⁰20 Fang YM, Dean R, Figueroa R. Right atrial myxoma mimicking an atrial thrombus in the third trimester of pregnancy. J Matern Fetal Neonatal Med. 2007;20(1):77-8.^,²¹21 Fiorilli R, Tomasco B, Serino W, Tesler UF. Asymptomatic left ventricular myxoma in pregnancy: echocardiographic diagnosis and surgical treatment. G Ital Cardiol. 1996;26(8):887-90.^,²⁹29 Korbel' M, Kanáliková K, Fischer V, Niznanská Z, Redecha M, Paulíková Z. Management of intracavitary left atrium tumors during pregnancy: two case reports. Zentralbl Gynakol. 2001;123(10):590-2.^,³⁵35 Nakata S, Nakano S, Mitsuda N, Itou N, Takahashi Y, Matsuda H. Recurrent left atrial myxoma in a patient with a twin fetus pregnancy. Jpn Circ J. 1996;60(2):130-2.^,³⁶36 Nelson SC, Coleman L, Zakowski MI. Management and cesarean delivery in a parturient with a right atrial mass. Abstract Number: F-30 [Accessed Aug 21, 2014]. Available at: http://soap.org/display_2012_abstract.php?id=F-30 http://soap.org/display_2012_abstract.ph... ^,³⁹39 Ogilvie M. 'I wanted him to have a chance to survive before me' [Accessed Aug 21, 2014]. Available at: http://www.thestar.com/life/health_wellness/2011/10/22/i_wanted_him_to_have_a_chance_to_survive_before_me.html http://www.thestar.com/life/health_welln... ^,⁴¹41 Roldán FJ, Vargas-Barrón J, Espinola-Zavaleta N, Keirns C, Romero-Cárdenas A. Recurrent myxoma implanted in the left atrial appendage. Echocardiography. 2000;17(2):169-71.^]	1 (8.3) ^[¹³13 Bryukhina EV, Ishchenko LS, Lomova ES, Ulanova DS. Left atrial myxoma in a pregnant woman: clinical features, tactics. Sci Pract J Obstet Gynecol. 2014;5(9):114-6.^]	3 (25) ^[¹¹11 Berberovic B, Kacila M, Hadzimehmedagic A, Berberovic E. Cardiac myxoma in diabetic pregnancy. Int J Gynaecol Obstet. 2014;125(3):281-2.^,¹²12 Bortolotti U, Scioti G, Guglielmi C, Milano A, Nardi C, Tartarini G. Recurrent myxoma of the left ventricle. Case report and review of the literature. J Cardiovasc Surg (Torino). 1999;40(2):233-5.^,³²32 Manfredini R, Calì G, Foresti A. Acute anterior myocardial infarction in a patient with left atrial myxoma during pregnancy. G Ital Cardiol. 1995;25(11):1419-24.^]
One-stage	2(100)	2 (100) ^[¹⁰10 Arumugam CG, Raju SV, Varma S, Bhaskaran K. Anaesthetic management of a pregnant patient with left atrial myxoma and myxoma excision of lower segment caesarean. Apollo Med. 2008;5(1):71-3.^,⁴⁵45 Smith A. Asymptomatic atrial myxoma during pregnancy. RCOG World Congress 2013 Liverpool UK, 24-26 June 2013 [Accessed Aug 21, 2014]. Available at: http://www.epostersonline.com/rcog2013/?q=node/409 http://www.epostersonline.com/rcog2013/?... ^]	0 (0)	0 (0)
χ²	19.5	1.8	0.8	5.5
P value	0.000	0.413	0.683	0.063

Authors’ roles & responsibilities
SMY	Study conception and design; analysis and/or interpretation of data; manuscript writing.

Sociedade Brasileira de Cirurgia Cardiovascular Rua Afonso Celso, 1178 Vila Mariana, CEP: 04119-061 - São Paulo/SP Brazil, Tel +55 (11) 3849-0341, Tel +55 (11) 5096-0079 - São Paulo - SP - Brazil
E-mail: bjcvs@sbccv.org.br

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[1] Correspondence address: Shi-Min Yuan, Longdejing Street, 389 - Chengxiang District, Putian, Fujian Province, People’s Republic of China. E-mail: shi_min_yuan@yahoo.com