51
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Ide T, Miyoshi T, Katsuragi S, Neki R, Kurosaki KI, Shiraishi I, Yoshimatsu J, Ikeda T. Prediction of postnatal arrhythmia in fetuses with cardiac rhabdomyoma. J Matern Fetal Neonatal Med 2018; 32:2463-2468. [DOI: 10.1080/14767058.2018.1438402] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Tetsuya Ide
- Department of Perinatology and Gynecology, Suita, Japan
| | - Takekazu Miyoshi
- Department of Perinatology and Gynecology, Suita, Japan
- Department of Obstetrics and Gynecology, Mie University, Tsu, Japan
| | | | - Reiko Neki
- Department of Perinatology and Gynecology, Suita, Japan
| | - Ken-ichi Kurosaki
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Isao Shiraishi
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Suita, Japan
| | | | - Tomoaki Ikeda
- Department of Obstetrics and Gynecology, Mie University, Tsu, Japan
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52
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Primary cardiac tumors associated with genetic syndromes: a comprehensive review. Pediatr Radiol 2018; 48:156-164. [PMID: 29214333 DOI: 10.1007/s00247-017-4027-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 09/08/2017] [Accepted: 11/03/2017] [Indexed: 12/30/2022]
Abstract
Various cardiac tumors occur in the setting of a genetic syndrome such as myxomas in Carney complex and rhabdomyomas in tuberous sclerosis. Tumor biology can be different in syndromic forms, and on imaging children sometimes demonstrate additional manifestations of the underlying syndrome. We discuss the imaging appearance of cardiac tumors occurring in the framework of a genetic syndrome, the findings that suggest an underlying syndrome, and the impact on management.
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Dahdah N. Everolimus for the Treatment of Tuberous Sclerosis Complex-Related Cardiac Rhabdomyomas in Pediatric Patients. J Pediatr 2017; 190:21-26.e7. [PMID: 28888564 DOI: 10.1016/j.jpeds.2017.06.076] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 06/14/2017] [Accepted: 06/30/2017] [Indexed: 01/24/2023]
Affiliation(s)
- Nagib Dahdah
- Division of Pediatric Cardiology, CHU Sainte-Justine, University of Montreal, Quebec, Canada.
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Prabhu N, Osifodunrin N, Murphy D, Butler S, Hunter LE. Innovative Strategies for the Management of a Massive Neonatal Rhabdomyoma. J Pediatr Intensive Care 2017; 7:90-93. [PMID: 31073477 DOI: 10.1055/s-0037-1606574] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 08/09/2017] [Indexed: 09/30/2022] Open
Abstract
Rhabdomyomas are histologically benign tumors known to be associated with tuberous sclerosis. The natural history predicts the majority of tumors to be asymptomatic and regress within the first year of life. We describe a neonate presenting on day 1 of life with cardiovascular collapse secondary to a massive rhabdomyoma. Surgical resection was excluded due to the extensive nature of the lesion and oral sirolimus, a mammalian target of rapamycin inhibitor, was commenced to promote tumor regression. The patient developed intractable arrhythmias requiring extracorporeal life support during therapy.
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Affiliation(s)
- N Prabhu
- Department of Paediatric Cardiology, Royal Hospital for Children, Glasgow, United Kingdom
| | - N Osifodunrin
- Department of Paediatric Oncology, Royal Hospital for Children, Glasgow, United Kingdom
| | - D Murphy
- Department of Paediatric Oncology, Royal Hospital for Children, Glasgow, United Kingdom
| | - S Butler
- Department of Paediatric Radiology, Royal Hospital for Children, Glasgow, United Kingdom
| | - L E Hunter
- Department of Paediatric Cardiology, Royal Hospital for Children, Glasgow, United Kingdom
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Morais MJ, Silva F, Melo M, Carriço A, Valente F. Prenatal Diagnosis of Intracardiac Tumors. Arq Bras Cardiol 2017; 107:605-606. [PMID: 28558077 PMCID: PMC5210465 DOI: 10.5935/abc.20160183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 05/23/2016] [Indexed: 11/24/2022] Open
Affiliation(s)
| | - Fátima Silva
- Centro Hospitalar de Vila Nova de Gaia, Espinho, Portugal
| | - Mónica Melo
- Centro Hospitalar de Vila Nova de Gaia, Espinho, Portugal
| | - Ana Carriço
- Centro Hospitalar de Vila Nova de Gaia, Espinho, Portugal
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Bejiqi R, Retkoceri R, Bejiqi H. Prenatally Diagnosis and Outcome of Fetuses with Cardiac Rhabdomyoma - Single Centre Experience. Open Access Maced J Med Sci 2017; 5:193-196. [PMID: 28507627 PMCID: PMC5420773 DOI: 10.3889/oamjms.2017.040] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 02/22/2017] [Accepted: 02/24/2017] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Cardiac rhabdomyoma (CRs) are the most common primary tumour of the heart in infants and children. Usually are multiple and, basing on the location can cause a haemodynamic disturbance, dysrhythmias or heart failure during the fetal and early postnatal period. CRs have a natural history of spontaneous regression and are closely associated with tuberous sclerosis complex (TSC). It has an association with tuberous sclerosis (TS), and in those, the tumour may regress and disappear completely, or remain consistent in size. AIM We aimed to evaluate the prenatal diagnosis, clinical presentation and outcome of CRs and their association with TSC in a single centre. The median follow-up period was three years (range: 6 months - 5 years). MATERIAL AND METHODS We reviewed medical records of all fetuses diagnosed prenatally with cardiac rhabdomyoma covering the period January 2010 to December 2016 which had undergone detailed ultrasound evaluation at a single centre with limited technical resources. RESULTS Twelve fetuses were included in the study; mostly had multiple tumours and a total of 53 tumours were identified in all patients - the maximum was one fetus with16 tumours. All patients were diagnosed prenatally by fetal echocardiography. In two patient's haemodynamic disturbances during the fetal period was noted and pregnancies have been terminated. After long consultation termination of pregnancy was chosen by the parents in totally 8 cases. In four continuing pregnancies during the first year of live tumours regressed. TSC was diagnosed in all patients during the follow-up. CONCLUSIONS Cardiac rhabdomyoma are benign from the cardiovascular standpoint in most affected fetuses. An early prenatal diagnosis may help for an adequate planning of perinatal monitoring and treatment with the involvement of a multidisciplinary team. Large tumour size, the number of tumours and localisation may cause hydrops, and they are significantly associated with poor neonatal outcome.
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Affiliation(s)
- Ramush Bejiqi
- Division of Cardiology, Pediatric Clinic, University Clinical Center of Kosovo, Prishtina, Kosovo
| | - Ragip Retkoceri
- Division of Cardiology, Pediatric Clinic, University Clinical Center of Kosovo, Prishtina, Kosovo
| | - Hana Bejiqi
- Main Center of Family Medicine, Prishtina, Kosovo
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57
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Aw F, Goyer I, Raboisson MJ, Boutin C, Major P, Dahdah N. Accelerated Cardiac Rhabdomyoma Regression with Everolimus in Infants with Tuberous Sclerosis Complex. Pediatr Cardiol 2017; 38:394-400. [PMID: 27878332 DOI: 10.1007/s00246-016-1528-y] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 11/11/2016] [Indexed: 01/25/2023]
Abstract
Tuberous sclerosis complex is associated with benign tumors such as cardiac rhabdomyomas (RHM) caused by the disinhibition of the mammalian target of rapamycin (mTOR) protein. Recent reports on everolimus, an mTOR inhibitor, have shown size reduction of RHM. We compared cases recently treated with everolimus to historic controls whose first echocardiography was within first month of life. The largest dimension of the largest RHM was reported as a percentage compared to the earliest echocardiography study. Treatment of the four cases was started at a median age of 6.5 days (range 2-20) with an initial enteral dose of 0.1 mg daily, aiming at a therapeutic serum trough level of 5-15 ng/mL. Median duration of everolimus treatment was 73 days (range 34-138). Compared to 10 historic controls, everolimus-treated patients had 11.8 times faster RHM size regression rate (slope -0.0285 vs. -0.0024; p < 0.001). The average time to 50% size reduction was 1.13 ± 0.33 month (range 0.66-1.4 months) with everolimus versus 72.9 ± 53.03 months in controls (p = 0.026). Following treatment with everolimus, one case was operated for congenital heart disease, without requirement of RHM resection, two others had the massive left ventricle RHM shrink to non-consequential size. The latter had a disappearance of RHM, but everolimus therapy was maintained to prevent the regrowth of a significant cerebral tumor. Everolimus is efficacious for size reduction of RHM during the neonatal period. With limited safety data, this approach should be used with caution in selective cases.
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Affiliation(s)
- Fatou Aw
- Division of Pediatric Cardiology, Department of Pediatrics, CHU Sainte-Justine, University of Montreal, 3175, Côte Sainte-Catherine, Montréal, QC, H3T 1C5, Canada
- Aristide le Dantec Hospital, Cheikh Anta Diop University, Dakar, Senegal
| | - Isabelle Goyer
- Division of Clinical Pharmacology, Department of Pharmacy, CHU Sainte-Justine, University of Montreal, Montréal, QC, Canada
| | - Marie-Josée Raboisson
- Division of Pediatric Cardiology, Department of Pediatrics, CHU Sainte-Justine, University of Montreal, 3175, Côte Sainte-Catherine, Montréal, QC, H3T 1C5, Canada
| | - Christine Boutin
- Division of Pediatric Cardiology, Department of Pediatrics, CHU Sainte-Justine, University of Montreal, 3175, Côte Sainte-Catherine, Montréal, QC, H3T 1C5, Canada
| | - Philippe Major
- Department of Neurological Sciences, CHU Sainte-Justine, University of Montreal, Montréal, QC, Canada
| | - Nagib Dahdah
- Division of Pediatric Cardiology, Department of Pediatrics, CHU Sainte-Justine, University of Montreal, 3175, Côte Sainte-Catherine, Montréal, QC, H3T 1C5, Canada.
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Erhunmwunsee L, Flanagan RP, Jaquiss RDB, Lodge AJ. Atrial Rhabdomyoma Resection With Extracellular Matrix Reconstruction of the Right Atrial Free Wall in an Infant. World J Pediatr Congenit Heart Surg 2016; 7:769-772. [DOI: 10.1177/2150135115610718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 09/09/2015] [Indexed: 11/15/2022]
Abstract
A neonate was diagnosed with a mediastinal mass after presenting with bradycardia. At surgery, she was found to have a 4-cm mass replacing most of the right atrial free wall. After tumor resection, the right atrium was reconstructed with an extracellular matrix biomaterial that supports native tissue regeneration. Her pathology revealed rhabdomyoma, which is rare in patients without tuberous sclerosis. The procedure was well tolerated but was complicated by narrowing of the superior vena cava that required dilation postoperatively.
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Affiliation(s)
- Loretta Erhunmwunsee
- Division of Thoracic Surgery, Department of Surgery, City of Hope, Duarte, CA, USA
| | - Ryan P. Flanagan
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Robert D. B. Jaquiss
- Division of Pediatric Cardiology, Department of Pediatrics, Womack Army Medical Center, Fort Bragg, NC, USA
| | - Andrew J. Lodge
- Division of Pediatric Cardiology, Department of Pediatrics, Womack Army Medical Center, Fort Bragg, NC, USA
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Więckowska K, Piątek K, Respondek-Liberska M. Heart Tumors in 33 Fetuses - Review of Twenty-Two Years of the Single-Centre Experience. PRENATAL CARDIOLOGY 2016. [DOI: 10.1515/pcard-2016-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
INTRODUCTION: Cardiac tumors (CT) have been diagnosed since the eighties of the last century. The three most commonly diagnosed types of CT are rhabdomyomas, teratomas and fibromas. Severe fetal disturbances, such as arrythmias, fetal hydrops, ventricular obstructions, may be associated with the heart tumor.
AIM OF THE STUDY: To present the key role of the echocardiographic examination in the perinatal care and to present some demographic changes in this population of the youngest patients.
MATERIAL AND METHODS: From the Filemaker database of the Department for Diagnosis and Prevention of Congenital Malformations, Polish Mother’s Memorial Hospital & Medical University of Lodz, all cases with prenatal diagnoses of cardiac tumor in singleton pregnancy were compiled over a 22-year period (1993–2015). 33 cases of heart tumors in fetuses had 72 fetal echo examinations. The average number of cases per year was 1,5 (range 1 – 5). The retrospective analysis of the material was performed using the Statistica package. The analysis included the assessment of the cardiovascular condition defined by Cardiovascular Profile Score, location and number of tumors; age, past obstetric history, place of residence of the mother, type of delivery and neonatal follow-up.
RESULTS: The number of fetuses with cardiac tumor cases did not increase during this period. The maternal age was 28,1 years (± 5,2 years) and was decreasing over time. The primigravidae constituted 60% of examined population. The history of past miscarriages was observed in 26% of women. The majority of tumors were detected and diagnosed in the third trimester – at mean 29,6 hbd, but the diagnosis was made earlier in the past decades (regression analysis, p=0,042). The average duration of pregnancy was 36,6 hbd (range: 27-42 hbd). There was no statistical difference between decades in term on pregnancy duration.
The cardiac tumors were more frequent in the female fetuses (71,4% to 28,6%; X2 test; p=0,006). The proportions between the groups of single and multiple tumors changed in last five years – currently the multiple tumors are more frequent (87,5%). The mortality in the group of single tumors was twice as high as in the group of multiple tumors. The percentage of cesarean sections between 1993 and 2005 was 67% and between 2006 and 2015 was 75% (p=0,63). The mortality of neonates with cardiac tumors declined over the period taken into account.
CONCLUSIONS: The perinatal care of the fetuses with cardiac tumors improved over last 20 years. The characteristics of analyzed population had shown that fetal CTs affected healthy, young mothers, more often primigravidae, more often female fetuses. The prevalence of CTs did not increase over time. The gestational age at the time of the diagnosis decreased, thus the period of fetal echo monitoring increased. However, the rate of cesarean sections also increased, which requires further studies and explanations.
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Affiliation(s)
- Katarzyna Więckowska
- 1. Medical University of Lodz, 5th Grade, Scientific Student's Circle of Prenatal Cardiology
| | - Katarzyna Piątek
- 1. Medical University of Lodz, 5th Grade, Scientific Student's Circle of Prenatal Cardiology
| | - Maria Respondek-Liberska
- 2. Department of Diagnoses and Prevention Fetal Malformations, Medical University of Lodz, Poland
- 3. Department of Prenatal Cardiology, Polish Mother’s Memorial Hospital Research Institute, Lodz, Poland
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60
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Ramadani N, Kreshnike KD, Muçaj S, Kabashi S, Hoxhaj A, Jerliu N, Bejiçi R. MRI Verification of a Case of Huge Infantile Rhabdomyoma. Acta Inform Med 2016; 24:146-8. [PMID: 27147810 PMCID: PMC4851540 DOI: 10.5455/aim.2016.24.146-148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 03/11/2016] [Indexed: 11/29/2022] Open
Abstract
Introduction: Cardiac rhabdomyoma is type of benign myocardial tumor that is the most common fetal cardiac tumor. Cardiac rhabdomyomas are usually detected before birth or during the first year of life. They account for over 60% of all primary cardiac tumors. Case report: A 6 month old child with coughing and obstruction in breathing, was hospitalized in the Pediatric Clinic in UCCK, Pristine. The difficulty of breathing was heard and the pathological noise of the heart was noticed from the pediatrician. In the echo of the heart at the posterior and apico-lateral part of the left ventricle a tumoral mass was presented with the dimensions of 56 × 54 mm that forwarded the contractions of the left ventricle, the mass involved also the left ventricle wall and was not vascularized. The right ventricle was deformed and with the shifting of the SIV on the right the contractility was preserved. Aorta, the left arch and AP were normal with laminar circulation. The pericard was presented free. Radiography of thoracic organs was made; it resulted on cardiomegaly and significant bronchovascular drawing. It was completed with an MRI and it resulted on: Cardiomegaly due to large tumoral mass lesion (60×34 mm) involving lateral wall of left ventricle. It was isointense to the muscle on T1W images, markedly hyperintense on T2W images. There were a few septa or bant like hypointensities within lesion. On postcontrast study it showed avid enhancement. The left ventricle volume was decreased. Mild pericardial effusion was also noted. Surgical intervention was performed and it resulted on the histopathological aspect as a huge infantile rhadbomyoma. Conclusion: In most cases no treatment is required and these lesions regress spontaneously. Patients with left ventricular outflow tract obstruction or refractory arrhythmias respond well to surgical excision. Rhabdomyomas are frequently diagnosed by means of fetal echocardiography during the prenatal period.
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Affiliation(s)
- Naser Ramadani
- Faculty of Medicine, Pristine University, Pristine, Kosovo; National Institute of Public Health of Kosovo, Pristine, Kosovo
| | - Kreshnike Dedushi Kreshnike
- Faculty of Medicine, Pristine University, Pristine, Kosovo; Department of Radiology, Diagnostic Centre, UCCK, Pristine, Kosovo; International Health Center "IHC" Pristine, Kosovo
| | - Sefedin Muçaj
- Faculty of Medicine, Pristine University, Pristine, Kosovo; National Institute of Public Health of Kosovo, Pristine, Kosovo
| | - Serbeze Kabashi
- Faculty of Medicine, Pristine University, Pristine, Kosovo; Department of Radiology, Diagnostic Centre, UCCK, Pristine, Kosovo
| | | | - Naim Jerliu
- Faculty of Medicine, Pristine University, Pristine, Kosovo; National Institute of Public Health of Kosovo, Pristine, Kosovo
| | - Ramush Bejiçi
- Faculty of Medicine, Pristine University, Pristine, Kosovo; Pediatric Clinic, Department of Cardiology UCCK, Pristine, Kosovo
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61
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Aydin E, Turgal M, Nuhoglu E, Ozyuncu O. Prenatal diagnosis and outcomes of fetal cardiac rhabdomyomas: evaluation of seven cases. CASE REPORTS IN PERINATAL MEDICINE 2015. [DOI: 10.1515/crpm-2015-0041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
In this case series, we aimed to determine the outcome of prenatally diagnosed fetal cardiac rhabdomyoma. This case series is a retrospective evaluation of seven cases of fetal cardiac rhabdomyoma determined during pregnancy. Only one of these cases has been associated with tuberous sclerosis (TS). Two of the cases had just a single tumor, whereas the others were found to have multiple tumors. Termination was performed to one fetus due to hydrops fetalis. The presence of risk factors of TS in a family and multifocal or large tumors, appears to be the most important factors affecting neonatal outcomes.
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Affiliation(s)
- Emine Aydin
- Division of Maternal Fetal Medicine, Faculty of Medicine, Department of Obstetrics and Gynecology, Hacettepe University, Sıhhiye, Ankara, Turkey
| | - Mert Turgal
- Division of Maternal Fetal Medicine, Faculty of Medicine, Department of Obstetrics and Gynecology, Hacettepe University, Sıhhiye, Ankara, Turkey
| | - Esra Nuhoglu
- Division of Maternal Fetal Medicine, Faculty of Medicine, Department of Obstetrics and Gynecology, Hacettepe University, Sıhhiye, Ankara, Turkey
| | - Ozgur Ozyuncu
- Division of Maternal Fetal Medicine, Faculty of Medicine, Department of Obstetrics and Gynecology, Hacettepe University, Sıhhiye, Ankara, Turkey
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62
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Ghaisas SD, Seshadri S, Suresh B. Outcome of Antenatally Diagnosed Cardiac Rhabdomyoma: Case Series from a Tertiary Fetal Medicine Center in India. JOURNAL OF FETAL MEDICINE 2015. [DOI: 10.1007/s40556-015-0042-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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63
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Mlczoch E, Hanslik A, Luckner D, Kitzmüller E, Prayer D, Michel-Behnke I. Prenatal diagnosis of giant cardiac rhabdomyoma in tuberous sclerosis complex: a new therapeutic option with everolimus. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 45:618-621. [PMID: 24913039 DOI: 10.1002/uog.13434] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 05/20/2014] [Accepted: 05/23/2014] [Indexed: 06/03/2023]
Abstract
Tuberous sclerosis complex (TSC) is a genetic disorder characterized by abnormal cell proliferation and tumor growth in a number of organ systems, primarily the brain, kidneys, eyes and heart. Clinical symptoms vary according to the location of the tumor. The most common disorders are seizures, neurodevelopmental disorders, renal failure and arrhythmias. TSC was found to be influenced by inhibitors of the protein kinase mammalian target of rapamycin (mTOR), which regulates abnormal cellular proliferation. mTOR inhibitors have been studied effectively in patients with subependymal giant-cell astrocytomas and renal angiolipomas in the context of TSC. We describe a prenatally diagnosed case of giant rhabdomyoma, due to right ventricular outflow tract obstruction, which presented as a duct-dependent lesion. Postnatal treatment with the mTOR inhibitor everolimus initiated significant regression of the cardiac tumor. This finding suggests that mTOR inhibitor therapy is an option for giant rhabdomyomas that develop in the neonatal period.
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Affiliation(s)
- E Mlczoch
- Pediatric Heart Center, Department of Pediatrics and Adolescent Medicine, Division for Pediatric Cardiology, Medical University of Vienna, Vienna, Austria
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64
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Goyer I, Dahdah N, Major P. Use of mTOR inhibitor everolimus in three neonates for treatment of tumors associated with tuberous sclerosis complex. Pediatr Neurol 2015; 52:450-3. [PMID: 25682485 DOI: 10.1016/j.pediatrneurol.2015.01.004] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 01/05/2015] [Accepted: 01/07/2015] [Indexed: 10/24/2022]
Abstract
BACKGROUND Tuberous sclerosis complex is characterized by the growth of benign tumors in multiple organs, caused by the disinhibition of the mammalian target of rapamycin (mTOR) protein. mTOR inhibitors, such as everolimus, are used in patients with tuberous sclerosis complex, mainly to reduce the size of renal angiomyolipomas and subependymal giant cell astrocytomas. There are minimal data available regarding its use during the neonatal period. METHODS We report clinical and pharmacological data of three neonates treated with the mTOR inhibitor everolimus (two hemodynamically significant cardiac rhabdomyomas and one voluminous subependymal giant cell astrocytoma). RESULTS Beneficial clinical responses were observed in all three patients and the medication was generally well-tolerated. Optimal dose was 0.1 mg orally once daily and was confirmed with therapeutic drug monitoring. CONCLUSION Everolimus is a promising pharmacological approach to treat clinically significant inoperable cardiac rhabdomyomas or subependymal giant cell astrocytoma associated with tuberous sclerosis complex during the neonatal period.
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Affiliation(s)
- Isabelle Goyer
- Department of Pharmacy, CHU Sainte-Justine, University of Montreal, Montreal, Quebec, Canada
| | - Nagib Dahdah
- Division of Pediatric Cardiology, CHU Sainte-Justine, University of Montreal, Montreal, Quebec, Canada
| | - Philippe Major
- Department of Neurosciences, CHU Sainte-Justine, University of Montreal, Montreal, Quebec, Canada.
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65
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van der Pol CB, McInnes MDF, Petrcich W, Tunis AS, Hanna R. Is quality and completeness of reporting of systematic reviews and meta-analyses published in high impact radiology journals associated with citation rates? PLoS One 2015; 10:e0119892. [PMID: 25775455 PMCID: PMC4361663 DOI: 10.1371/journal.pone.0119892] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 01/20/2015] [Indexed: 01/01/2023] Open
Abstract
Purpose The purpose of this study is to determine whether study quality and completeness of reporting of systematic reviews (SR) and meta-analyses (MA) published in high impact factor (IF) radiology journals is associated with citation rates. Methods All SR and MA published in English between Jan 2007–Dec 2011, in radiology journals with an IF >2.75, were identified on Ovid MEDLINE. The Assessing the Methodologic Quality of Systematic Reviews (AMSTAR) checklist for study quality, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist for study completeness, was applied to each SR & MA. Each SR & MA was then searched in Google Scholar to yield a citation rate. Spearman correlation coefficients were used to assess the relationship between AMSTAR and PRISMA results with citation rate. Multivariate analyses were performed to account for the effect of journal IF and journal 5-year IF on correlation with citation rate. Values were reported as medians with interquartile range (IQR) provided. Results 129 studies from 11 journals were included (50 SR and 79 MA). Median AMSTAR result was 8.0/11 (IQR: 5–9) and median PRISMA result was 23.0/27 (IQR: 21–25). The median citation rate for SR & MA was 0.73 citations/month post-publication (IQR: 0.40–1.17). There was a positive correlation between both AMSTAR and PRISMA results and SR & MA citation rate; ρ=0.323 (P=0.0002) and ρ=0.327 (P=0.0002) respectively. Positive correlation persisted for AMSTAR and PRISMA results after journal IF was partialed out; ρ=0.243 (P=0.006) and ρ=0.256 (P=0.004), and after journal 5-year IF was partialed out; ρ=0.235 (P=0.008) and ρ=0.243 (P=0.006) respectively. Conclusion There is a positive correlation between the quality and the completeness of a reported SR or MA with citation rate which persists when adjusted for journal IF and journal 5-year IF.
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Affiliation(s)
| | - Matthew D. F. McInnes
- Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- * E-mail:
| | - William Petrcich
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Adam S. Tunis
- Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada
| | - Ramez Hanna
- Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada
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Shukla AK, Reddy AK, Latha A, Jayamohan AE. Cardiac rhabdomyoma: an antenatal illustration. BMJ Case Rep 2015; 2015:bcr-2014-209256. [PMID: 25766445 DOI: 10.1136/bcr-2014-209256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Anil Kumar Shukla
- Department of Radiology, Kempegowda Institute of Medical Sciences, Bangalore, Karnataka, India
| | - Ajit Kumar Reddy
- Department of Radiology, Mahatma Gandhi Medical College & Research Institute, Puducherry, India
| | - Asha Latha
- Department of Obstetrics, Ayur Sanjeevini, Bangalore, Karnataka, India
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Mohamed I, Ethier G, Goyer I, Major P, Dahdah N. Oral everolimus treatment in a preterm infant with multifocal inoperable cardiac rhabdomyoma associated with tuberous sclerosis complex and a structural heart defect. BMJ Case Rep 2014; 2014:bcr-2014-205138. [PMID: 25427930 DOI: 10.1136/bcr-2014-205138] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Rhabdomyoma (RHM) is a benign cardiac tumour usually associated with tuberous sclerosis complex (TSC). Most RHMs are asymptomatic and regress spontaneously during the first years of life. Haemodynamically significant RHMs are classically treated with surgical excision. We present a case of a premature infant, born to a mother having TSC, with a prenatal diagnosis of pulmonary valve atresia and a large ventricular septal defect. Multiple cardiac RHMs were also present, including a large tumour affecting the right ventricular filling. Owing to the prematurity and low birth weight, the infant was inoperable. In this report, we describe our approach to pharmacologically reduce the RHM size using oral everolimus in preparation for a two-ventricle surgical repair of the structural cardiac defect. We also specifically describe the dose of everolimus that was used in this case to achieve therapeutic serum levels, which was seven times lower than the conventional dose applicable for older infants.
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Affiliation(s)
- Ibrahim Mohamed
- Department of Neonatology, CHU Ste-Justine, Montreal, Canada
| | | | - Isabelle Goyer
- Department of Neonatology, CHU Ste-Justine, Montreal, Canada
| | - Philippe Major
- Division of Pediatric Cardiology, CHU Ste-Justine, Montreal, Canada
| | - Nagib Dahdah
- Division of Pediatric Cardiology, CHU Ste-Justine, Montreal, Canada
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68
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Hinton RB, Prakash A, Romp RL, Krueger DA, Knilans TK. Cardiovascular manifestations of tuberous sclerosis complex and summary of the revised diagnostic criteria and surveillance and management recommendations from the International Tuberous Sclerosis Consensus Group. J Am Heart Assoc 2014; 3:e001493. [PMID: 25424575 PMCID: PMC4338742 DOI: 10.1161/jaha.114.001493] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Robert B Hinton
- Division of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH (R.B.H., T.K.K.)
| | - Ashwin Prakash
- Department of Cardiology, Boston Children's Hospital, Boston, MA (A.P.)
| | - Robb L Romp
- Division of Pediatric Cardiology, University of Alabama at Birmingham, AL (R.L.R.)
| | - Darcy A Krueger
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH (D.A.K.)
| | - Timothy K Knilans
- Division of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH (R.B.H., T.K.K.)
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69
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Li YD, He YH, Li ZA, Wei P. Right atrial cardiac rhabdomyoma with premature foramen ovale restriction: A case report. Oncol Lett 2014; 8:2553-2556. [PMID: 25364426 PMCID: PMC4214446 DOI: 10.3892/ol.2014.2605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Accepted: 08/20/2014] [Indexed: 11/06/2022] Open
Abstract
Fetal cardiac rhabdomyoma is the most common cardiac tumor in fetuses. However, this benign tumor can cause hemodynamic repercussions and intrauterine fetal mortality. The present study reports a case of rare fetal cardiac rhabdomyoma located in the right atrium, accompanied by premature restriction of the foramen ovale and moderate pericardial effusion, as determined by tomographic ultrasound imaging (TUI). Fetal mortality subsequently occurred late in the second trimester of pregnancy and the diagnosis was confirmed by pathology. The present study discusses the occurrence and diagnosis of this rare abnormality. TUI mode with spatio-temporal image correlation offline imaging provides the physician with clear views of abnormal intracardiac structures in the beating heart. With improvements in sonographic technology, the diagnosis of fetal cardiac rhabdomyoma may be easier and more accurate in the clinical arena.
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Affiliation(s)
- Yi-Dan Li
- Department of Ultrasound, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, P.R. China
| | - Yi-Hua He
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, P.R. China
| | - Zhi-An Li
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, P.R. China
| | - Ping Wei
- Department of Pathology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, P.R. China
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70
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Longardt AC, Nonnenmacher A, Graul-Neumann L, Opgen-Rhein B, Henrich W, Bührer C, Hüseman D. Fetal intracardiac rhabdomyoma in beckwith-wiedemann syndrome. JOURNAL OF CLINICAL ULTRASOUND : JCU 2014; 42:569-573. [PMID: 24752985 DOI: 10.1002/jcu.22164] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 01/05/2014] [Accepted: 03/24/2014] [Indexed: 06/03/2023]
Abstract
Fetal cardiac tumors are a rare finding in prenatal ultrasonography. Most of them are rhabdomyoma, which are thought to be pathognomonic for tuberous sclerosis complex. We present an infant with prenatally diagnosed cardiac rhabdomyoma (CR), who was found to suffer from Beckwith-Wiedemann syndrome (BWS). This congenital overgrowth syndrome is characterized by macrosomia, macroglossia, omphalocele, hypoglycemia, and hemihypertrophy. BWS patients have an increased risk for formation of benign and malignant tumors, typically intra-abdominally located, but, to the best of our knowledge, fetal CRs have not been reported before. BWS must be added to the list of differential diagnoses and to the prenatal counseling of the parents in cases of prenatal detection of CR.
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71
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Mir A, Ikemba CM, Veeram Reddy SR. Hypoplastic left heart syndrome secondary to intrauterine rhabdomyoma necessitating single ventricle palliation. Ann Pediatr Cardiol 2014; 7:207-9. [PMID: 25298697 PMCID: PMC4189239 DOI: 10.4103/0974-2069.140851] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Rhabdomyoma, a benign hamartomatous tumor of the cardiac embryonic myocyte, is the most common intrauterine cardiac tumor and accounts for 0.12% of prenatal fetal studies. Fetal cardiac rhabdomyomas increase in size during second and early third trimester and spontaneously regress postnatally. The clinical presentation is usually benign, however, compromise of the ventricular outflow tract leading to decreased cardiac output and fetal death have been reported. We present a case of large cardiac rhabdomyoma in a fetus that might have caused complete left ventricular outflow tract obstruction and development of hypoplastic left heart syndrome (HLHS) necessitating postnatal single ventricle palliation therapy. The clinical course and outcomes of prenatally diagnosed cardiac rhabdomyoma are reviewed and theories of the development of hypoplastic left heart syndrome are explored.
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Affiliation(s)
- Arshid Mir
- Department of Pediatrics, Division of Cardiology, Oklahoma University Children Hospital, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Catherine Minor Ikemba
- Department of Pediatrics, Division of Cardiology, University of Texas Southwestern Medical Center, Children Medical Center Dallas, Dallas, Texas, USA
| | - Surendranath R Veeram Reddy
- Department of Pediatrics, Division of Cardiology, University of Texas Southwestern Medical Center, Children Medical Center Dallas, Dallas, Texas, USA
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Abstract
We report a case of a neonate who presented to us with multiple rhabdomyomas of heart, cortical tubers in the brain and skeletal anomalies such as Pierre Robin sequence, bilateral clubfoot and lower small bowel obstruction. Though a diagnosis of neonatal tuberous sclerosis was made, the association of skeletal anomalies and intestinal obstruction was a rare and unusual finding.
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Affiliation(s)
- Deeparaj Ganapati Hegde
- Department of Neonatology, Lokmanya Tilak Municipal Medical College and Hospital, Sion, Mumbai, Maharashtra, India
| | - Jayashree Mondkar
- Department of Neonatology, Lokmanya Tilak Municipal Medical College and Hospital, Sion, Mumbai, Maharashtra, India
| | - Harshad Panchal
- Department of Neonatology, Lokmanya Tilak Municipal Medical College and Hospital, Sion, Mumbai, Maharashtra, India
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73
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Cho JY, Lee YH. Fetal tumors: prenatal ultrasonographic findings and clinical characteristics. Ultrasonography 2014; 33:240-51. [PMID: 25116458 PMCID: PMC4176115 DOI: 10.14366/usg.14019] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 06/19/2014] [Accepted: 06/20/2014] [Indexed: 11/03/2022] Open
Abstract
The incidence of fetal tumors has been increased due to generalization of prenatal evaluation and improvement of imaging techniques. The early detection of a fetal tumor and understanding of its imaging features are very important for fetal, maternal, and neonatal care. Ultrasonography is usually used for the detection and differential diagnosis of fetal tumors, and magnetic resonance imaging is increasingly being used as a complementary study. Many fetal tumors have different clinical and imaging features compared with pediatric tumors. Although several fetal tumors may mimic other common anomalies, some specific imaging features may carry early accurate diagnosis of fetal tumors, which may alter the prenatal management of a pregnancy and the mode of delivery, and facilitate immediate postnatal treatment.
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Affiliation(s)
- Jeong Yeon Cho
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea ; Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea ; Kidney Research Institute, Seoul National University Medical Research Center, Seoul, Korea
| | - Young Ho Lee
- Department of Radiology, Cheil General Hospital & Women's Healthcare Center, Kwandong University College of Medicine, Seoul, Korea
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74
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Rovira À, Ruiz-Falcó ML, García-Esparza E, López-Laso E, Macaya A, Málaga I, Vázquez É, Vicente J. Recommendations for the radiological diagnosis and follow-up of neuropathological abnormalities associated with tuberous sclerosis complex. J Neurooncol 2014; 118:205-223. [PMID: 24771286 DOI: 10.1007/s11060-014-1429-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Accepted: 03/28/2014] [Indexed: 01/25/2023]
Abstract
Tuberous sclerosis complex (TSC) is a genetic condition with multisystem involvement, characterized by the development of tumors and other abnormalities in organs such as the brain, retina, skin, heart, kidneys, and lungs. Most patients have neuropathological abnormalities such as cortical tubers, white matter radial migration lines, subependymal nodules, and subependymal giant cell astrocytomas (SEGAs). These lesions are associated with different neurological manifestations that are frequently associated with TSC. These manifestations consist of epilepsy, intellectual disability, and neurobehavioral and psychiatric problems, including autism spectrum disorder. Hydrocephalus may also develop in patients with SEGAs due to ventricular obstruction, when this usually slow-growing tumor reaches sufficient size. Surgery has been the classical approach to treat SEGAs, although this treatment is associated with substantial morbidity and does not completely prevent tumor recurrence. Recently, the mammalian target of rapamycin (mTOR) inhibitor, everolimus, has been approved by the Food and Drug Administration and the European Medicines Agency for the treatment of patients with SEGAs associated with TSC. However, the treatment of SEGAs with these agents requires the development of guidelines that establish a differential diagnosis between SENs and SEGAs, in which neuroradiological examinations play an essential role. With the aim of improving the neuroradiological diagnosis and follow-up of the neuropathological abnormalities associated with TSC, a group of experts in this field has reviewed different aspects related to these issues and put together, a series of statements and recommendations intended to provide guidance to specialists involved in the management of TSC.
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Affiliation(s)
- Àlex Rovira
- Neuroradiology Unit (IDI), Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - María Luz Ruiz-Falcó
- Neuropediatrics Department, Hospital Infantil Universitario Niño Jesús, Avenida de Menéndez Pelayo, 65, 28009, Madrid, Spain.
| | - Elena García-Esparza
- Neuroradiology Department, Hospital Infantil Universitario Niño Jesús, Avenida de Menéndez Pelayo, 65, 28009, Madrid, Spain
| | - Eduardo López-Laso
- Neuropediatrics Department, Hospital Universitario Reina Sofía, Avenida Menéndez Pidal, s/n, 14004, Córdoba, Spain
| | - Alfons Macaya
- Neuropediatrics Department, Hospital Universitari Vall D'Hebron, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Ignacio Málaga
- Child Neurology Unit, Pediatrics Department, Hospital Universitario Central de Asturias, Calle de Celestino Villamil, s/n, 33006, Oviedo, Spain
| | - Élida Vázquez
- Pediatric Radiology Department, Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Josefina Vicente
- Neuroradiology Department, Hospital Universitario Reina Sofía, Avenida Menéndez Pidal, s/n, 14004, Córdoba, Spain
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Donofrio MT, Moon-Grady AJ, Hornberger LK, Copel JA, Sklansky MS, Abuhamad A, Cuneo BF, Huhta JC, Jonas RA, Krishnan A, Lacey S, Lee W, Michelfelder EC, Rempel GR, Silverman NH, Spray TL, Strasburger JF, Tworetzky W, Rychik J. Diagnosis and treatment of fetal cardiac disease: a scientific statement from the American Heart Association. Circulation 2014; 129:2183-242. [PMID: 24763516 DOI: 10.1161/01.cir.0000437597.44550.5d] [Citation(s) in RCA: 707] [Impact Index Per Article: 70.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND The goal of this statement is to review available literature and to put forth a scientific statement on the current practice of fetal cardiac medicine, including the diagnosis and management of fetal cardiovascular disease. METHODS AND RESULTS A writing group appointed by the American Heart Association reviewed the available literature pertaining to topics relevant to fetal cardiac medicine, including the diagnosis of congenital heart disease and arrhythmias, assessment of cardiac function and the cardiovascular system, and available treatment options. The American College of Cardiology/American Heart Association classification of recommendations and level of evidence for practice guidelines were applied to the current practice of fetal cardiac medicine. Recommendations relating to the specifics of fetal diagnosis, including the timing of referral for study, indications for referral, and experience suggested for performance and interpretation of studies, are presented. The components of a fetal echocardiogram are described in detail, including descriptions of the assessment of cardiac anatomy, cardiac function, and rhythm. Complementary modalities for fetal cardiac assessment are reviewed, including the use of advanced ultrasound techniques, fetal magnetic resonance imaging, and fetal magnetocardiography and electrocardiography for rhythm assessment. Models for parental counseling and a discussion of parental stress and depression assessments are reviewed. Available fetal therapies, including medical management for arrhythmias or heart failure and closed or open intervention for diseases affecting the cardiovascular system such as twin-twin transfusion syndrome, lung masses, and vascular tumors, are highlighted. Catheter-based intervention strategies to prevent the progression of disease in utero are also discussed. Recommendations for delivery planning strategies for fetuses with congenital heart disease including models based on classification of disease severity and delivery room treatment will be highlighted. Outcome assessment is reviewed to show the benefit of prenatal diagnosis and management as they affect outcome for babies with congenital heart disease. CONCLUSIONS Fetal cardiac medicine has evolved considerably over the past 2 decades, predominantly in response to advances in imaging technology and innovations in therapies. The diagnosis of cardiac disease in the fetus is mostly made with ultrasound; however, new technologies, including 3- and 4-dimensional echocardiography, magnetic resonance imaging, and fetal electrocardiography and magnetocardiography, are available. Medical and interventional treatments for select diseases and strategies for delivery room care enable stabilization of high-risk fetuses and contribute to improved outcomes. This statement highlights what is currently known and recommended on the basis of evidence and experience in the rapidly advancing and highly specialized field of fetal cardiac care.
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Abstract
We report the case of a large congenital rhabdomyoma of the interventricular septum diagnosed prenatally. The foetus was strictly monitored with ultrasound throughout the gestation period showing that the mass had increased in size until delivery. Despite the size of the mass, which appeared to occupy the right ventricle, the baby presented no symptoms both in utero and after birth. Serial echocardiography was used to document the regression of the mass in childhood.
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77
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Tunis AS, McInnes MDF, Hanna R, Esmail K. Association of Study Quality with Completeness of Reporting: Have Completeness of Reporting and Quality of Systematic Reviews and Meta-Analyses in Major Radiology Journals Changed Since Publication of the PRISMA Statement? Radiology 2013; 269:413-26. [DOI: 10.1148/radiol.13130273] [Citation(s) in RCA: 122] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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78
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Sapre S, Yadav C, Patel V, Chandwaskar N. Fetal Bradyarrythmia: Are We Missing Something? J Obstet Gynaecol India 2013; 63:342-3. [DOI: 10.1007/s13224-012-0182-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2011] [Accepted: 04/23/2012] [Indexed: 11/24/2022] Open
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79
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Detection of maternal transmission of a splicing mutation in the TSC2 gene following prenatal diagnosis of fetal cardiac rhabdomyomas mimicking congenital cystic adenomatoid malformation of the lung and cerebral tubers and awareness of a family history of maternal epilepsy. Taiwan J Obstet Gynecol 2013; 52:415-9. [DOI: 10.1016/j.tjog.2013.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2013] [Indexed: 11/20/2022] Open
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Karadeniz C, Ciftçi O, Demir F, Atalay S, Uçar T, Tutar E. Reflection of paternal tuberous sclerosis in the fetus: cardiac rhabdomyoma. J OBSTET GYNAECOL 2013; 33:627-8. [PMID: 23919866 DOI: 10.3109/01443615.2013.810203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- C Karadeniz
- Pediatric Cardiology Unit, Department of Pediatrics, Ankara University Faculty of Medicine, Cebeci, Ankara, Turkey.
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81
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Naqvi N, Rigby M, Cyriac J, Carvalho JS. Fetal diagnosis of left ventricular tumour with pericardial extension persisting into childhood. Arch Dis Child Fetal Neonatal Ed 2013; 98:F355. [PMID: 22684161 DOI: 10.1136/fetalneonatal-2012-301842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Nitha Naqvi
- Royal Brompton Hospital, Sydney Street, London, UK.
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82
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Pucci A, Botta G, Sina N, Tibaldi M, Valori A, Grosso E, Zonta A, Giudici M, Agnoletti G, Bergamasco L, Abbruzzese PA, Bartoloni G. Life-threatening tumors of the heart in fetal and postnatal age. J Pediatr 2013; 162:964-9.e1. [PMID: 23219450 DOI: 10.1016/j.jpeds.2012.10.055] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Revised: 10/12/2012] [Accepted: 10/30/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate the role of histology in diagnosis and management of biologically benign heart tumors causing life-threatening symptoms and even death in children and fetuses. The clinical impact of a multidisciplinary approach including 2-D echocardiography, histology, genetics, and cardiac surgery has not yet been fully elucidated. STUDY DESIGN Forty-one consecutive antenatal (n = 17) or postnatal (n = 24) detected cardiac masses were evaluated by 2-D echocardiography (in alive patients) or at autopsy, and 12/41 cases with definite histologic diagnosis of primary and benign cardiac tumor were entered in this study. RESULTS Rhabdomyomas (n = 6), hemangiomas (n = 3), central fibrous body chondroma (n = 1), fibroma (n = 1), or left atrial myxoma (n = 1) were histologically diagnosed in 4 fetuses and in 8 children. Death occurred in 6 patients showing diffuse or infiltrative tumors, 2/6 experiencing intrauterine death or sudden and unexpected infant death. Seven patients underwent surgery, 4/7 are alive and well at >5 years follow-up, whereas 3 deaths followed partial tumor resection. Two fetuses with extensive tumor/s were aborted. Tuberous sclerosis complex gene mutations were seen in patients with rhabdomyomas. CONCLUSIONS Histology represents the best diagnostic approach in life-threatening pediatric cardiac tumors allowing definite diagnosis in cases other than rhabdomyoma and in sudden deaths, influencing clinical management and counselling. 2-D echocardiography remains the main tool for early clinical diagnosis and follow-up. A multidisciplinary approach is advisable because of rarity, difficult management, and possible associations with inheritable diseases.
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Affiliation(s)
- Angela Pucci
- Department of Anatomic Pathology, University Hospital, Pisa, Italy.
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83
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Lee KA, Won HS, Shim JY, Lee PR, Kim A. Molecular genetic, cardiac and neurodevelopmental findings in cases of prenatally diagnosed rhabdomyoma associated with tuberous sclerosis complex. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2013; 41:306-311. [PMID: 22791573 DOI: 10.1002/uog.11227] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/18/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVE Rhabdomyoma is the most common type of cardiac tumor in fetuses and is often associated with tuberous sclerosis complex (TSC) with neurologic sequelae. The purpose of this study was to investigate the cardiac and neurodevelopmental outcomes of fetal rhabdomyoma. METHODS We reviewed the clinical characteristics of 23 cases of cardiac rhabdomyoma diagnosed prenatally by fetal echocardiography at the Asan Medical Center between January 1998 and December 2009. We also reviewed postnatal results of brain magnetic resonance imaging, echocardiography, renal ultrasound examination and molecular genetic analysis to confirm the presence of cardiac rhabdomyoma with or without TSC. RESULTS Among 23 cases, outcome data were available for 17 (73.9%) and six cases (26.1%) were lost to follow-up. The survival rate was 100.0% (17/17). Among the 17 cases with outcome data, spontaneous tumor regression occurred in eight (47.1%), and no change in tumor size and number was observed in the remaining nine cases (52.9%). There was no evidence of long-term cardiac dysfunction caused by persisting rhabdomyomas, regardless of tumor size. TSC was found in nine patients (52.9%), of whom five (55.6%) showed neurodevelopmental morbidity. We identified mutations in one of the TSC1 or TSC2 genes in four of nine TSC infants whose parents allowed us to perform molecular genetic analysis. Three of these (75.0%) were found to have neurologic impairment. Seven (77.8%) of nine TSC cases were non-familial. CONCLUSIONS The overall outcome of isolated cardiac rhabdomyoma appears to be favorable. We suggest that systematic postnatal evaluation of TSC be performed even in cases of cardiac rhabdomyoma without a family history of TSC. Molecular characterization of TSC1 and TSC2 might be helpful in predicting short- and long-term neurodevelopmental outcomes.
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Affiliation(s)
- K A Lee
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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84
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Cardiac tumors in infants and children: study of 120 operated patients. Pediatr Cardiol 2013; 34:125-8. [PMID: 22735896 DOI: 10.1007/s00246-012-0399-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Accepted: 05/17/2012] [Indexed: 10/28/2022]
Abstract
Cardiac tumors in children are rare, and patient series are limited in size. We report 120 children who underwent surgery to treat a cardiac tumor; the tumor type was known in 108 instances. The patients represented <0.1 % of 130,000 cardiac surgeries performed in children from a multi-institutional data base. The most common tumors and the number of patients were rhabdomyoma (n = 42), myxoma (n = 28), and fibromas (n = 10). The remaining 18 tumors of various types occurred in smaller numbers of patients. Nine patients (7 %) died after surgery. The mean age of death was 14 days, and death was most frequent in patients with fibromas (n = 4). Considering the variety of tumors, their varied location in cardiac structures, the patient ages, and the infrequent occurrence in an individual surgeon's experience, the operative mortality was low.
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85
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Pruksanusak N, Suntharasaj T, Suwanrath C, Phukaoloun M, Kanjanapradit K. Fetal cardiac rhabdomyoma with hydrops fetalis: report of 2 cases and literature review. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2012; 31:1821-1824. [PMID: 23091254 DOI: 10.7863/jum.2012.31.11.1821] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Rhabdomyoma is the most common cardiac tumor in fetuses, often associated with the tuberous sclerosis complex, especially when multiple tumors and a positive family history of tuberous sclerosis are noted. The tumor is often benign and has a tendency to regress but may increase in size until the early third trimester. Fetal cardiac rhabdomyoma complicated by hydrops fetalis and leading to fetal death is rare. We report 2 cases of fetal cardiac rhabdomyoma with hydrops fetalis and provide a review of the literature.
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Affiliation(s)
- Ninlapa Pruksanusak
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110 Thailand.
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86
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Multimodal imaging in the prenatal diagnosis of tuberous sclerosis complex. Case Rep Pediatr 2012; 2012:925646. [PMID: 23082268 PMCID: PMC3467776 DOI: 10.1155/2012/925646] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Accepted: 09/04/2012] [Indexed: 11/17/2022] Open
Abstract
Tuberous sclerosis complex (TSC) is an autosomal dominant disorder in which benign hamartomas develop in multiple organ systems. Increasingly, stigmata of the disease, such as cardiac rhabdomyomas, are detected on routine prenatal ultrasound. Such a finding should prompt additional imaging studies in order to confirm diagnosis and to identify potential complications, which vary greatly from patient to patient. Early diagnosis allows for accurate parental counseling, coordination of high-level perinatal care, and subspecialty followup. We present a case of TSC in utero wherein access to and use of multiple imaging modalities confirmed diagnosis and allowed the patient to receive optimal care prior to birth.
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Rabdomioma intracardiaco fetal como causa de trasplante cardiaco en recién nacido: a propósito de un caso. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2012. [DOI: 10.1016/j.gine.2011.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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88
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Ozeren S, Cakiroglu Y, Doger E, Caliskan E. Sonographic diagnosis of fetal cardiac rhabdomyomas in two successive pregnancies in a woman with tuberous sclerosis. JOURNAL OF CLINICAL ULTRASOUND : JCU 2012; 40:179-182. [PMID: 22287098 DOI: 10.1002/jcu.21890] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2010] [Accepted: 12/14/2011] [Indexed: 05/31/2023]
Abstract
Rhabdomyoma is the most common prenatally diagnosed cardiac tumor. We present two cases of fetal cardiac rhabdomyoma. In each case, fetal ultrasound assessment revealed the intracardiac tumors that were confirmed on postnatal imaging. The mother and her previous child were examined for the markers of tuberous sclerosis and diagnosis of tuberous sclerosis was confirmed. Two years later, cardiac rhabdomyomas were again diagnosed in her subsequent pregnancy. In the postpartum period, total regression of the tumors occurred in both cases.
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Affiliation(s)
- Semih Ozeren
- Kocaeli University, School of Medicine, Department of Obstetrics and Gynecology, Kocaeli, Turkey
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89
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Hallett L, Foster T, Liu Z, Blieden M, Valentim J. Burden of disease and unmet needs in tuberous sclerosis complex with neurological manifestations: systematic review. Curr Med Res Opin 2011; 27:1571-83. [PMID: 21692602 DOI: 10.1185/03007995.2011.586687] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Tuberous sclerosis complex (TSC) is a progressive genetic disorder characterized by pervasive benign tumor growth. We sought to assess the current understanding of burden of TSC-related neurological manifestations. METHODS We systematically searched MEDLINE- and EMBASE-indexed, English-language literature (5/2000-5/2010) and non-indexed materials. RESULTS In total, 119 articles were included, 115 on epidemiology and treatment. Recent prevalence estimates from Ireland and Taiwan report TSC in 1:14,000-25,000 individuals, below older estimates of 1:10,000. While neurological manifestations are common, treatment is largely unaddressed by guidelines and focuses on symptoms, with resection standard for subependymal giant cell astrocytomas (SEGAs) and common practice for refractory epilepsy. Antiepileptic drugs and mammalian target of rapamycin inhibitors safely, effectively minimize the need for surgery for severe epilepsy and SEGAs. CONCLUSION Morbidity and treatment burden of prevalent neurological manifestations is significant, suggesting substantial economic and humanistic burden; however, these areas are poorly studied, indicating total disease burden is unknown. Future research should assess quality of life, caregiver burden, and costs.
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90
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Sharma J, Inglis S, Cavalieri R, Udom-Rice I. Fetal demise secondary to massive rhabdomyoma in the early second trimester of pregnancy. Pediatr Cardiol 2011; 32:243-4. [PMID: 21188367 DOI: 10.1007/s00246-010-9874-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2010] [Accepted: 12/08/2010] [Indexed: 10/18/2022]
Abstract
Rhabdomyoma is the most common cardiac tumor in fetuses, often associated with tuberous sclerosis complex and usually diagnosed in the third trimester of pregnancy, with a benign course in the majority of cases. The hemodynamic impact of cardiac tumor depends on the location and size of the mass and the presence of dysrhythmia (4). Fetal cardiac rhabdomyoma accounts for less than 10% of fetal demise cases (1). This report presents a case of massive cardiac rhabdomyoma filling the entire right heart with pericardial extension, leading to hydrops and subsequent fetal death in the early second trimester of pregnancy.
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Affiliation(s)
- J Sharma
- Division of Pediatric Cardiology, Jamaica Hospital Medical Center, 8900, Van Wyck Expressway, Jamaica, NY 11418, USA.
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91
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De Rosa G, De Carolis MP, Pardeo M, Bersani I, Tempera A, De Nisco A, Caforio L, Romagnoli C, Piastra M. Neonatal Emergencies Associated with Cardiac Rhabdomyomas: An 8-Year Experience. Fetal Diagn Ther 2011; 29:169-77. [DOI: 10.1159/000320483] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2009] [Accepted: 08/20/2010] [Indexed: 11/19/2022]
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92
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Serikawa T, Takahashi Y, Kikuchi A, Takakuwa K, Usuda T, Hasegawa S, Tanaka K. A Case of Infantile Cardiac Rhabdomyoma Complicated by Tuberous Sclerosis. Cardiol Res 2010; 1:24-26. [PMID: 28352373 PMCID: PMC5358235 DOI: 10.4021/cr104e] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2010] [Indexed: 11/03/2022] Open
Abstract
We experienced a case with fetal cardiac tumor, which was diagnosed by prenatal ultrasonographic examination, and the diagnosis was confirmed after birth. A pregnancy woman of the 26th week of gestation was referred to our hospital for close examinations of fetal cardiac tumor. Ultrasonographic examinations revealed single homogeneous tumor with the diameter of 14 mm intracardiac space. The tumor was considered to emerge from the ventricular septum and to be occupied in left ventricle. Other cardiac abnormalities were not detected. The fetus was diagnosed to be complicated with the intracardiac tumor, and with the possible rhabdomyoma of heart. The serial ultrasonographic examinations revealed that the fetal cardiac function was normal. The size of the tumor gradually increased, although the fetal cardiac function revealed within normal range. The patient delivered a female infant weighing 2716g with the Apgar score of 9 and 10 at one and 5 minutes after delivery. The infant was confirmed to have cardiac tumors after examination by pediatric cardiologist, and the cardiac function of the infant was diagnosed as normal condition. The computed tomography of the head revealed the intracranial multiple calcification lesions, which indicated the symptoms of tuberous sclerosis.
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Affiliation(s)
- Takehiro Serikawa
- Department of Obstetrics and Gynecology, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Yasuhiro Takahashi
- Department of Obstetrics and Gynecology, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Akira Kikuchi
- Department of Obstetrics and Gynecology, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Koichi Takakuwa
- Department of Obstetrics and Gynecology, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Tohei Usuda
- Department of Pediatrics, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Satoshi Hasegawa
- Department of Pediatrics, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Kenichi Tanaka
- Department of Obstetrics and Gynecology, Niigata University Medical and Dental Hospital, Niigata, Japan
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93
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Díaz-García C, Hidalgo J, Domene J, Saez-Palacios J, Perales A. Bradiarritmia como forma de presentación inusual de rabdomioma cardíaco fetal. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2010. [DOI: 10.1016/j.gine.2009.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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94
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Yinon Y, Chitayat D, Blaser S, Seed M, Amsalem H, Yoo SJ, Jaeggi ET. Fetal cardiac tumors: a single-center experience of 40 cases. Prenat Diagn 2010; 30:941-9. [DOI: 10.1002/pd.2590] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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95
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Niewiadomska-Jarosik K, Stańczyk J, Janiak K, Jarosik P, Moll JJ, Zamojska J, Respondek-Liberska M. Prenatal diagnosis and follow-up of 23 cases of cardiac tumors. Prenat Diagn 2010; 30:882-7. [DOI: 10.1002/pd.2586] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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96
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Jain D, Maleszewski JJ, Halushka MK. Benign cardiac tumors and tumorlike conditions. Ann Diagn Pathol 2010; 14:215-30. [DOI: 10.1016/j.anndiagpath.2009.12.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2009] [Accepted: 12/22/2009] [Indexed: 10/19/2022]
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97
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Approaches to the management of antenatally diagnosed congenital tumours. Pediatr Radiol 2009; 39:1173-8. [PMID: 19277637 DOI: 10.1007/s00247-009-1163-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2008] [Accepted: 11/23/2008] [Indexed: 10/21/2022]
Abstract
Congenital fetal tumours are rare, but current imaging modalities including US and MRI facilitate antenatal diagnosis and investigation, allowing a presumptive diagnosis and management strategy. Although the prevalence of fetal tumours is difficult to ascertain, an incidence of 7.2 per 100,000 live births has previously been reported, with the incidence of neonatal malignancy estimated at 36.5 per million births. Teratomas and neuroblastomas are the most common solid tumours described. Tumours may be very large or associated with severe hydrops leading to significant dystocia with the potential for difficult vaginal or caesarean delivery. Once the diagnosis of a fetal tumour is made, optimal management incorporates a multidisciplinary approach including obstetrician, neonatologist, paediatric surgeon and paediatric oncologist so that counselling is appropriate and a clear management plan is in place for parents.
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98
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Saada J, Hadj Rabia S, Fermont L, Le Bidois J, Bernardes LS, Martinovic J, Sonigo P, Dumez Y, Bonnet D, Benachi A. Prenatal diagnosis of cardiac rhabdomyomas: incidence of associated cerebral lesions of tuberous sclerosis complex. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2009; 34:155-159. [PMID: 19606448 DOI: 10.1002/uog.6367] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVES To determine the prevalence of specific cerebral lesions of tuberous sclerosis complex (TSC) and neurological outcome in cases diagnosed prenatally with cardiac rhabdomyomas. METHODS We reviewed all fetuses diagnosed prenatally with cardiac rhabdomyomas which had undergone detailed ultrasound evaluation and cerebral magnetic resonance imaging (MRI) and which were recorded in the database of a single institution covering the period January 1992 to December 2005. RESULTS Fifty-one fetuses were included in the study. MRI was performed at a mean +/- SD gestational age of 30 +/- 3 gestational weeks and showed specific lesions of TSC in 49% of cases. Termination of pregnancy was chosen by the parents in 26 cases. Neurological development was studied in 20 cases, follow-up lasting 4.8 +/- 2.9 years. Neurodevelopmental events occurred during the follow-up period in 45% of cases. Neurological complications occurred in 67% of patients who had cerebral lesions at MRI and in 33% of patients with normal MRI results. There was no significant difference between the two groups of patients (P = 0.2). CONCLUSION In fetuses with cardiac rhabdomyomas detailed ultrasound examination and third-trimester cerebral MRI are able to diagnose most TSC cerebral lesions, but fail to determine neurological outcome.
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Affiliation(s)
- J Saada
- Maternité, Université Paris-Descartes, Faculté de Médecine, AP-HP, Hôpital Necker-Enfants Malades, Paris, France.
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Chockalingam P, Clur SAB, Wilde AAM, Kuipers I, van Woensel J, Blom NA. Implantable cardioverter defibrillator as a bridge to recovery in an infant with cardiac rhabdomyoma. Eur J Pediatr 2009; 168:863-6. [PMID: 18815808 DOI: 10.1007/s00431-008-0837-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2008] [Accepted: 09/04/2008] [Indexed: 11/27/2022]
Abstract
Multiple cardiac rhabdomyomas in an infant presented with recurrent life-threatening ventricular arrhythmias refractory to medical treatment and necessitating the placement of an implantable cardioverter defibrillator (ICD). The device functioned effectively as a bridge to recovery during a 2-year follow-up period, when the tumor showed spontaneous regression, along with an almost complete resolution of the ventricular arrhythmias. We conclude that childhood cardiac rhabdomyomas causing severe drug-refractory ventricular arrhythmias can be managed by ICD therapy.
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Affiliation(s)
- Priya Chockalingam
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
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