78th Annual PostGraduate Assembly in Anesthesiology (PGA78) 2024

A Diagnostic Dilemma and Considerations for Delivery of a Parturient with a Right Atrial Cardiac Mass

Aria Lucchesi, M.D.; Rhiannon Kelsh-Lasher, M.D.; Jacqueline Donovan, M.D.; Saroj Pani, M.D.

Albany Medical Center, Department of Anesthesiology

•23-year-old G1P0 presented at 25 weeks with palpitations and dyspnea

•Pregnancy complicated by hyperemesis gravidarum

•PICC line placed for TPN given severe HG

•Despite resolution of hyperemesis, continued to have worsening dyspnea

•EKG showed right axis deviation

•TTE revealed 2-3cm mass in the right atrium

•Concern for myxoma vs thrombus

•Patient placed on prophylactic enoxaparin & followed by cardiothoracic surgery outpatient

•At 32 weeks, she was admitted for significantly worsening symptoms

•Scheduled cesarean delivery at 33 weeks

•Performed under neuraxial anesthesia

•2101-g living infant was delivered (APGAR scores 3, 7)

•Six days postpartum à staged cardiac intervention with sternotomy & cardiopulmonary bypass for excision of the mass

•Intra-op TEE showed unexpected pathology

•Unexpectedly, final pathology revealed a mass-forming thrombus with myxoid spindle cell elements.

A Diagnostic Dilemma and Considerations for Delivery of a Parturient with a Right Atrial Cardiac Mass