Treatment sequencing for intracardiac masses in pregnancy: a 10-year retrospective cohort of 21 patients

Abstract Background Intracardiac masses during pregnancy are rare, and treatment decisions must balance timely maternal surgery against fetal exposure to cardiopulmonary bypass (CPB). We evaluated a 10-year single-center experience, focusing on gestational-age-based treatment sequencing and maternal and pregnancy outcomes. Methods We retrospectively reviewed 21 women who underwent surgery for an intracardiac mass associated with pregnancy between April 2016 and July 2026. Strategies were classified by actual sequence: antenatal surgery with intended pregnancy continuation, delivery followed by cardiac surgery during the same anesthetic session, postpartum cardiac surgery, and concurrent early-pregnancy termination and surgery. Follow-up ended on 31 August 2026. Analyses were descriptive. Results Histopathology showed 19 myxomas, 1 hemangioma, and 1 lipoma. Antenatal surgery with intended pregnancy continuation was performed in 14 women at 15.8 ± 3.4 gestational weeks; delivery-prioritized management in 4 at 35–39 weeks; postpartum surgery in 2 at 49 and 57 days after delivery; and concurrent termination and surgery in 1 at 9 weeks. Mean CPB time was 55.9 ± 17.9 min; mean aortic cross-clamp time was 34.2 ± 16.1 min among 20 patients who underwent cross-clamping. There were 17 live births (81.0%), 3 terminations (14.3%), and 1 ongoing pregnancy (4.8%). No in-hospital maternal death or predefined major maternal perioperative complication occurred. Median maternal follow-up was 23.9 months (range, 1.3–124.1), with no death or tumor recurrence documented. Conclusions Individualized sequencing of cardiac surgery and delivery was associated with favorable observed outcomes in this selected surgical cohort. Antenatal resection may be considered before fetal maturity when maternal risk precludes waiting, whereas delivery before cardiac surgery may be appropriate near fetal maturity. These findings support multidisciplinary planning in experienced centers, while conclusions remain constrained by the observational design and small sample size.