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Eur J Cardiothorac Surg 2006;30:412
© 2006 Elsevier Science NL

Letter to the Editor

Reply to Tellez-Zenteno

Thierry Christophe Roth, Ralph Alexander Schmid*

Division of General Thoracic Surgery, University Hospital, CH-3010 Berne, Switzerland

Received 18 April 2006; accepted 19 April 2006.

* Corresponding author. Tel.: +41 31 632 23 30; fax: +41 31 632 23 27. (Email: ralph.schmid{at}insel.ch).

Key Words: Myasthenia gravis • Thymectomy • Pregnancy • Transient neonatal myasthenia gravis • Prognosis

We thank Dr Tellez-Zenteno for his interesting remarks. We appreciate his valuable study on 18 patients, which we unfortunately did not cite [1]. Of course, we know the limitations of our own study, but it seems that the Mexican group comes to the same conclusion, that thymectomy should be recommended before pregnancy and that radical thymectomy during pregnancy or in the early post-partum period should be avoided [2].

Despite the unpredictable course of myasthenia gravis (MG), most of the studies in the literature seem to demonstrate that the majority of patients have an unchanged (or improved) stage of MG during pregnancy [3] and that the radical thymectomy results independently in a more stable course of MG and long-term benefit (Table 3: literature overview, from our previous study) [4].

The fact that we did not observe a single case of a myasthenic newborn in the group of thymectomized mothers is not an isolated observation. Although other studies did not describe a statistically relevant difference in the rate of neonatal myasthenia between nonthymectomized or thymectomized mothers, Papatestas et al. [5] reported that the incidence of myasthenic newborns of women who had not undergone thymectomy was twice that of the thymectomy group. In addition, we cannot confirm the contraindication of breast-feeding by mothers with MG, which is often advocated empirically.

We hope that our paper has stimulated further research in this field.

References

  1. Tellez-Zenteno JF, Hernandez-Ronqillo L, Salinas V, Estanol B, da Silva O. Myasthenia gravis and pregnancy: clinical implications and neonatal outcome. BMC Musculoskelet Disord 2004;5(1):42.[CrossRef][Medline]
  2. Burke ME. Myasthenia gravis and pregnancy. J Perinat Neonatal Nurs 1993;7(1):11-21.[Medline]
  3. Ossermann KE. Pregnancy in myasthenia gravis and neonatal myasthenia gravis. Am J Med 1955;19:718-721.[Medline]
  4. Roth T, Ackermann R, Stein R, Inderbitzi R, Rosler K, Schmid RA. Thirteen years follow-up after radical transsternal thymectomy for myasthenia gravis. Do short-term results predict long-term outcome?. Eur J Cardiothorac Surg 2002;21(4):664-670.[Abstract/Free Full Text]
  5. Papatestas AE, Alpert LI, Ossermann KE, Ossermann RS, Kark AE. Studies in myasthenia gravis: effects of thymectomy. Results on 185 patients with nonthymomatous and thymomatous myasthenia gravis, 1941–1969. Am J Med 1971;50:465.[CrossRef][Medline]




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