101
|
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]
|
102
|
Sudden death of a young child due to cardiac rhabdomyoma. Pediatr Cardiol 2010; 31:894-6. [PMID: 20505929 DOI: 10.1007/s00246-010-9731-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2010] [Accepted: 05/05/2010] [Indexed: 12/31/2022]
Abstract
This report describes a 1(1/2)-year-old boy who succumbed to acute obstruction of the left ventricular outflow tract by a cardiac rhabdomyoma. He was admitted to have a transient loss of consciousness episode evaluated. A mobile intracardiac mass obstructing the left ventricular outflow tract and protruding into the aortic root during systole was detected by transthoracic echocardiography. At autopsy, it was confirmed to be a rhabdomyoma.
Collapse
|
103
|
Goldberg SP, Knott-Craig CJ, Boston US, Mari GC, Colvin EV, Chin TK. Surgical Management of Unusual Cardiac Tumors in Infants and Children. World J Pediatr Congenit Heart Surg 2010; 1:211-6. [DOI: 10.1177/2150135110372527] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
While most primary tumors of the heart are histologically benign, they are significant space-occupying lesions with serious functional implications for the heart and lungs. Herein, we highlight our experience with the surgical management of selected cardiac tumors in the pediatric population between 2008 and 2010. (1) Intrapericardial teratomas in the fetus can produce fatal tamponade from compression by the attendant pericardial effusion, and a critical life-saving maneuver preoperatively is to drain the effusion prenatally, followed by an expeditious resection after birth. (2) Rhabdomyomas, the most common of the pediatric cardiac tumors, can be intracavitary, large, and associated with the mitral subvalvular apparatus. (3) Cardiac fibromas should be aggressively resected or at least debulked, especially given their propensity for dysrrhythmias. The key to success is as complete a resection as possible, but not at the expense of other normal structures. (4) Complex nonobstructive hypertrophic myopathy can be thought of as a type of neoplastic overgrowth, and aggressive resection of even midcavitary obstructive lesions should be considered as a viable alternative to primary transplantation.
Collapse
Affiliation(s)
- Steven P. Goldberg
- University of Tennessee Medical Group/Le Bonheur Children’s Medical Center, Memphis, Tennessee
| | | | - Umar S. Boston
- University of Tennessee Medical Group/Le Bonheur Children’s Medical Center, Memphis, Tennessee
| | | | | | - Thomas K. Chin
- University of Tennessee Medical Group/Le Bonheur Children’s Medical Center, Memphis, Tennessee
| |
Collapse
|
104
|
|
105
|
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]
|
106
|
Postnatal growth of rhabdomyoma prior to tumor regression. Pediatr Cardiol 2010; 31:541-4. [PMID: 20047026 DOI: 10.1007/s00246-009-9619-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2009] [Accepted: 12/10/2009] [Indexed: 10/20/2022]
Abstract
We report a case of a 1-month-old infant with multiple intracardiac rhabdomyomas. In contrast to the known natural history of rhabdomyomas to show postnatal regression, this patient showed marked tumor progression prior to initiation of tumor regression at 10 months of age. In the absence of pronounced cardiovascular compromise, this finding should serve to encourage continued conservative management of rhabdomyomas despite tumor progression.
Collapse
|
107
|
Fresneau B, Oberlin O, Brugières L, Valteau-Couanet D, Patte C. [Malignant primary cardiac tumors in childhood and adolescence]. Arch Pediatr 2010; 17:495-501. [PMID: 20338733 DOI: 10.1016/j.arcped.2010.02.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2008] [Revised: 03/10/2009] [Accepted: 02/11/2010] [Indexed: 11/19/2022]
Abstract
Primary heart tumors are uncommon in children. The majority of them are benign, with only 10% malignant. Among malignant cardiac tumors, sarcoma (rhabdomyosarcoma, angiosarcoma, synovial sarcoma) and lymphoma (Burkitt's lymphoma, large B-cell lymphoma, lymphoblastic lymphoma) predominate. There are few published pediatric series on malignant primary cardiac tumors. We report here 3 observations of primary malignant cardiac tumors, 2 cases of sarcoma (angiosarcoma and synovial sarcoma) and 1 case of Burkitt's lymphoma. A precise pathological diagnosis is necessary for the proper management of these patients. For sarcoma, treatment associates surgery and chemotherapy. Surgery should be as complete as possible because of the lack of chemotherapy sensitivity of some sarcomas, mainly angiosarcoma and synovial sarcoma. Therefore, the prognosis of cardiac sarcoma remains poor. For primary cardiac lymphoma, management should not be different from lymphoma in other locations. Chemotherapy is the main treatment, and surgery has to be used only when complications occur. Prognosis depends on histology and not lymphoma location, and so is better than the prognosis for sarcoma.
Collapse
MESH Headings
- Adolescent
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Burkitt Lymphoma/diagnosis
- Burkitt Lymphoma/drug therapy
- Burkitt Lymphoma/pathology
- Burkitt Lymphoma/surgery
- Chemotherapy, Adjuvant
- Combined Modality Therapy
- Cough/etiology
- Diagnosis, Differential
- Dyspnea/etiology
- Echocardiography
- Fatal Outcome
- Female
- Heart Atria/pathology
- Heart Atria/surgery
- Heart Neoplasms/diagnosis
- Heart Neoplasms/drug therapy
- Heart Neoplasms/pathology
- Heart Neoplasms/surgery
- Hemangiosarcoma/diagnosis
- Hemangiosarcoma/drug therapy
- Hemangiosarcoma/pathology
- Hemangiosarcoma/surgery
- Humans
- Male
- Neoplasm Recurrence, Local/diagnosis
- Neoplasm Recurrence, Local/pathology
- Neoplasm, Residual/diagnosis
- Neoplasm, Residual/pathology
- Pulmonary Heart Disease/diagnosis
- Pulmonary Heart Disease/etiology
- Sarcoma, Synovial/diagnosis
- Sarcoma, Synovial/drug therapy
- Sarcoma, Synovial/pathology
- Sarcoma, Synovial/surgery
- Superior Vena Cava Syndrome/diagnosis
- Superior Vena Cava Syndrome/etiology
- Tomography, X-Ray Computed
Collapse
Affiliation(s)
- B Fresneau
- Service d'oncologie pédiatrique, institut Gustave-Roussy, rue Camille-Desmoulins, 94800 Villejuif, France.
| | | | | | | | | |
Collapse
|
108
|
Abstract
Cardiac Tumors are very rare but have devastating consequences given that they involve such an important organ. The majority of tumors are benign myxomas, which can present in very subtle ways causing a subsequent delay in diagnosis. Routine echocardiography is advised for anybody who is feeling generally unwell, since myxomas can cause pyrexia of unknown origin. The use of cardiac imaging has increased the early diagnosis of these tumors. A total of 25% of cardiac tumors are malignant sarcomas and these have a highly aggressive behavior. Early detection of these tumors while they are resectable offers a possibility for cure in the future.
Collapse
Affiliation(s)
- Mary N Sheppard
- Department of Histopathology, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK
| | - Raad Mohiaddin
- Magnetic Resonance Unit, Department of Imaging, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK
| |
Collapse
|
109
|
Considerations for prenatal counselling of patients with cardiac rhabdomyomas based on their cardiac and neurologic outcomes. Cardiol Young 2010; 20:18-24. [PMID: 20092673 DOI: 10.1017/s1047951109992046] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Cardiac rhabdomyomas are benign cardiac tumours with few cardiac complications, but with a known association to tuberous sclerosis that affects the neurologic outcome of the patients. We have analysed the long-term cardiac and neurological outcomes of patients with cardiac rhabdomyomas in order to allow comprehensive prenatal counselling, basing our findings on the records of all patients seen prenatally and postnatally with an echocardiographic diagnosis of cardiac rhabdomyoma encountered from August, 1982, to September, 2007. We analysed factors such as the number and the location of the tumours to establish their association with a diagnosis of tuberous sclerosis, predicting the cardiac and neurologic outcomes for the patients.Cardiac complications include arrhythmias, obstruction of the ventricular outflow tracts, and secondary cardiogenic shock. Arrhythmias were encountered most often during the neonatal period, with supraventricular tachycardia being the commonest rhythm disturbance identified. No specific dimension or location of the cardiac rhabdomyomas predicted the disturbances of rhythm.The importance of the diagnosis of tuberous sclerosis is exemplified by the neurodevelopmental complications, with four-fifths of the patients showing epilepsy, and two-thirds having delayed development. The presence of multiple cardiac tumours suggested a higher risk of being affected by tuberous sclerosis. The tumours generally regress after birth, and cardiac-related problems are rare after the perinatal period. Tuberous sclerosis and the associated neurodevelopmental complications dominate the clinical picture, and should form an important aspect of the prenatal counselling of parents.
Collapse
|
110
|
Iriart X, Latrabe V, Thambo JB. Atypical evolution of rhabdomyoma documented by cardiac magnetic resonance imaging and echocardiography. Pediatr Cardiol 2010; 31:308-10. [PMID: 19936585 DOI: 10.1007/s00246-009-9591-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2009] [Accepted: 10/30/2009] [Indexed: 10/20/2022]
Affiliation(s)
- Xavier Iriart
- Department of Congenital Heart Disease, Bordeaux University Hospital, Magellan Avenue, 33600 Pessac, France.
| | | | | |
Collapse
|
111
|
Cardiac tumors: optimal cardiac MR sequences and spectrum of imaging appearances. AJR Am J Roentgenol 2009; 193:377-87. [PMID: 19620434 DOI: 10.2214/ajr.08.1895] [Citation(s) in RCA: 152] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE This article reviews the optimal cardiac MRI sequences for and the spectrum of imaging appearances of cardiac tumors. CONCLUSION Recent technologic advances in cardiac MRI have resulted in the rapid acquisition of images of the heart with high spatial and temporal resolution and excellent myocardial tissue characterization. Cardiac MRI provides optimal assessment of the location, functional characteristics, and soft-tissue features of cardiac tumors, allowing accurate differentiation of benign and malignant lesions.
Collapse
|
112
|
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.
Collapse
Affiliation(s)
- J Saada
- Maternité, Université Paris-Descartes, Faculté de Médecine, AP-HP, Hôpital Necker-Enfants Malades, Paris, France.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
113
|
Crespo Marcos D, Arias Castro S, Álvarez Martín T, Maroto Álvaro E. Lipoma auricular derecho en paciente de 14 años. An Pediatr (Barc) 2009; 71:84-6. [DOI: 10.1016/j.anpedi.2009.03.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2009] [Accepted: 03/31/2009] [Indexed: 11/24/2022] Open
|
114
|
Abstract
We describe an atypical myxoma in the right ventricular outflow tract of a 12-year old girl. After identification using echocardiography, we assessed its precise location and attachments by magnetic resonance imaging. Subsequent to surgical removal, histology confirmed the myxomatous nature of the tumour.
Collapse
|
115
|
Fatal cardiac arrest due to an unusual fibroma of the pulmonary valve. Pediatr Cardiol 2009; 30:536-9. [PMID: 19365666 DOI: 10.1007/s00246-008-9380-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2008] [Accepted: 12/25/2008] [Indexed: 10/20/2022]
Abstract
Fibroma, the second most common tumor in childhood, usually is a large solitary mass involving the ventricular septum or the left and rarely the right free ventricular wall. An unusual case of a 5.2-year-old boy with a large mass originating from the pulmonary valve is reported. The patient presented for evaluation of a murmur. Echocardiography and cardiac magnetic resonance imaging showed a large tumor extending from the distal right ventricular outflow tract through the pulmonary valve and into the main pulmonary artery causing moderate obstruction. The patient had a fatal cardiac arrest while awaiting surgery. The postmortem examination proved the tumor to be a fibroma.
Collapse
|
116
|
Salanitri J, Lisle D, Rigsby C, Slaughter R, Edelman R. Benign cardiac tumours: cardiac CT and MRI imaging appearances. J Med Imaging Radiat Oncol 2009; 52:550-8. [PMID: 19178628 DOI: 10.1111/j.1440-1673.2008.02010.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Primary benign cardiac tumours are rarely found in clinical practice and are generally evaluated with echocardiography. However, with the increasing usage of helical multislice CT, the initial detection and evaluation of these masses may be made by the radiologist during routine daily practice for other indications. The echocardiographic, CT and cardiac MRI appearances of various benign cardiac tumours and masses are described and illustrated in this review.
Collapse
Affiliation(s)
- J Salanitri
- Department of Medical Imaging, St Andrews Hospital, Spring Hill, Brisbane, Australia.
| | | | | | | | | |
Collapse
|
117
|
|
118
|
Wu KH, Mo XM, Liu YL. Clinical analysis and surgical results of cardiac myxoma in pediatric patients. J Surg Oncol 2009; 99:48-50. [DOI: 10.1002/jso.21175] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
119
|
Abstract
Rhabdomyomas are the most common cardiac tumours in children. They sometimes cause significant obstruction of the ventricular out flow tracts. We report a series of 3 neonates diagnosed antenatally with multiple rhabdomyomas, who developed significant obstruction of the ventricular outflow tracts following birth. They underwent surgical resection in the neonatal period with good outcome. Antenatal diagnosis of obstructive cardiac tumours allows for planning for appropriate early intervention.
Collapse
|
120
|
Patel A, Rigsby C, Young L. Cardiac teratoma of the interventricular septum with congenital aortic stenosis in a newborn. Pediatr Cardiol 2008; 29:1126-8. [PMID: 18704552 DOI: 10.1007/s00246-008-9281-5] [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: 03/27/2008] [Revised: 07/03/2008] [Accepted: 07/11/2008] [Indexed: 10/21/2022]
Abstract
A 10-day-old infant presented with tachypnea, harsh murmur, and cardiomegaly. Echocardiography revealed a multicystic mass invading the entire interventricular septum and protruding into the left ventricular cavity without left ventricular tract outflow tract obstruction and aortic stenosis. The mass was subsequently resected and biopsy revealed it to be a cardiac teratoma. We present an unusually rare case of an intramyocardial teratoma with associated congenital aortic stenosis.
Collapse
Affiliation(s)
- Angira Patel
- Department of Cardiology, Children's Memorial Hospital, Chicago, IL, USA.
| | | | | |
Collapse
|
121
|
Günther T, Schreiber C, Noebauer C, Eicken A, Lange R. Treatment strategies for pediatric patients with primary cardiac and pericardial tumors: a 30-year review. Pediatr Cardiol 2008; 29:1071-6. [PMID: 18600370 DOI: 10.1007/s00246-008-9256-6] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2008] [Revised: 04/19/2008] [Accepted: 06/04/2008] [Indexed: 11/24/2022]
Abstract
This study reviewed different types of primary cardiac and mediastinal tumors in infants and children as well as their clinical presentation and management. Altogether, 34 consecutive patients followed from 1976 through December 2005 were analyzed. Of these 34 patients, 14 (41%) underwent surgery and 20 (59%) with rhabdomyomas were managed conservatively. Histologic examination of the surgically resected tumors showed teratoma in four patients, rhabdomyoma in four patients, and hemangioma in two patients. Myxoma, myofibroma, neuroblastoma, and malignant fibrous histiocytoma were encountered in one patient each. Follow-up evaluation was completed for 97% of the patients and extended up to 30 years. Half of the nonsurgical patients with rhabdomyoma showed partial or complete spontaneous regression. One patient died after resection of a malignant histiocytoma, and one patient required a tumor-related reoperation. Freedom from tumor-related reoperation after 10 years was 91% +/- 8.7%. Of the survivors, 85% were New York Heart Association (NYHA) class 1, and 100% had sinus rhythm. Spontaneous tumor regression is common in rhabdomyoma and surgery, and is indicated only for symptomatic patients with hemodynamically significant intracardiac obstruction. For all other benign primary cardiac tumors, complete resection usually can be accomplished with good results. Patients with giant tumor masses compressing or infiltrating the heart frequently cannot undergo complete resection. For these patients, restoration/preservation of sufficient heart function is the primary goal. Malignant tumors are extremely rare in pediatric patients and have a very poor prognosis.
Collapse
Affiliation(s)
- Thomas Günther
- Department of Cardiovascular Surgery, German Heart Center at the Technical University, Lazarettstrasse, Munich, Germany
| | | | | | | | | |
Collapse
|
122
|
Baskin HJ. The pathogenesis and imaging of the tuberous sclerosis complex. Pediatr Radiol 2008; 38:936-52. [PMID: 18414839 DOI: 10.1007/s00247-008-0832-y] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2008] [Revised: 03/03/2008] [Accepted: 03/12/2008] [Indexed: 01/08/2023]
Abstract
Tuberous sclerosis complex (TSC) is an autosomal-dominant disorder characterized by the formation of hamartomatous lesions in multiple organ systems. It is the second most common neurocutaneous syndrome after neurofibromatosis type 1 and has been recognized since the late 1800s. Although the disease has complete penetrance, there is also high phenotypic variability: some patients have obvious signs at birth, while others remain undiagnosed for many years. In addition to skin lesions, TSC patients develop numerous brain lesions, angiomyolipoma (AMLs), lymphangiomyomatosis (LAM) in the lungs, cardiac rhabdomyomas, skeletal lesions, and vascular anomalies, all of which are well seen with medical imaging. Our knowledge of TSC genetics and pathophysiology has expanded dramatically in recent years: two genetic loci were discovered in the 1990s and recent elucidation of TSC's interaction with the mTOR pathway has changed how we manage the disease. Meanwhile, medical imaging is playing an increasingly important role in the diagnosis, management, and treatment of TSC. We provide an update on the genetics and pathophysiology of TSC, review its clinical manifestations, and explore the breadth of imaging features in each organ system, from prenatal detection of cardiac rhabdomyomas to monitoring rapamycin therapy to treatment of AMLs by interventional radiology.
Collapse
Affiliation(s)
- Henry J Baskin
- Department of Radiology, Cincinnati Children's Medical Center, 333 Burnet Ave., Cincinnati, OH 45229, USA.
| |
Collapse
|
123
|
Descartes M, Romp R, Franklin J, Biggio JR, Zehnbauer B. Constitutional H19 hypermethylation in a patient with isolated cardiac tumor. Am J Med Genet A 2008; 146A:2126-9. [DOI: 10.1002/ajmg.a.32421] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
124
|
|
125
|
Burke A, Virmani R. Pediatric heart tumors. Cardiovasc Pathol 2008; 17:193-8. [PMID: 18402818 DOI: 10.1016/j.carpath.2007.08.008] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2007] [Revised: 08/27/2007] [Accepted: 08/28/2007] [Indexed: 01/28/2023] Open
Affiliation(s)
- Allen Burke
- CVPath Institute, Gaithersburg, MD 20878, USA.
| | | |
Collapse
|
126
|
Gazit AZ, Gandhi SK. Pediatric primary cardiac tumors: Diagnosis and treatment. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2008; 9:399-406. [PMID: 17897569 DOI: 10.1007/s11936-007-0060-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Primary cardiac tumors are rare in pediatrics. Their clinical presentation differs among the various age groups (fetus to the young adult). Our discussion focuses on the diagnosis and treatment of rhabdomyomas, fibromas, myxomas, and pericardial teratomas in the fetus and neonatal stages. Fetal diagnosis has been described in association with rhabdomyomas, fibromas, and pericardial teratomas. It is made by echocardiography prompted by fetal dysrhythmias, nonimmune hydrops, intrauterine growth restriction, and familial tuberous sclerosis. Based on our experience, it is of the utmost importance to refer these patients to a tertiary center for detailed evaluation, follow-up, and delivery. Tumor diagnosis in the neonatal age group may be prompted by a murmur, dysrhythmia, conduction block, and hemodynamic compromise or hypoxemia due to right or left inflow or outflow tract obstruction. Prenatal diagnosis of a hemodynamically significant mass mandates the presence of a neonatal intensivist in the delivery room for prompt initiation of advanced life support (intubation, mechanical ventilation, and central venous access), and early initiation of prostaglandin E(1) to establish ductus arteriosus patency. Severe inflow obstruction associated with a restrictive atrial septum may require balloon atrial septostomy. Emergent transvenous pacing is indicated in the face of high-degree atrioventricular block. Early surgical removal of the mass after initial stabilization in the neonatal or cardiac intensive care unit may be indicated.
Collapse
Affiliation(s)
- Avihu Z Gazit
- Department of Pediatrics, Washington University in Saint Louis, One Children's Place, NWT Box 8116, St. Louis, MO 63110, USA.
| | | |
Collapse
|
127
|
|
128
|
Abstract
Primary cardiac tumours are rare in children. Of these, papillary fibroelastomas are unusual but benign, usually being found in adults. There are only sporadic cases reported in children. We diagnosed such a papillary fibroelastoma involving the tricuspid valve in an asymptomatic child during a routine cardiac investigation.
Collapse
|
129
|
Scanlan D, Radio SJ, Nelson M, Zhou M, Streblow R, Prasad V, Reyes C, Perry D, Fletcher S, Bridge JA. Loss of the PTCH1 gene locus in cardiac fibroma. Cardiovasc Pathol 2007; 17:93-7. [PMID: 18329553 DOI: 10.1016/j.carpath.2007.08.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2007] [Revised: 07/23/2007] [Accepted: 08/08/2007] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Cardiac fibroma (CF) is a rare benign tumor that is poorly characterized genetically. CF is more commonly encountered in patients with Gorlin syndrome (3%) than the general population. Mutations of the tumor suppressor gene PTCH1 are the underlying cause of Gorlin syndrome. METHODS Conventional cytogenetic analysis was performed on a peripheral blood and a CF sample from a 2-week-old male. In addition, fluorescence in situ hybridization (FISH) studies were performed to assess the copy number of the PTCH1 gene locus (9q22.3) on metaphase and interphase cells from these same specimens using yeast artificial protein (YAC) probe 891G1 and on representative paraffin-embedded tissue sections of two additional CFs (one arising in a 2-month-old female and the other in a 13-week-old male). None of the patients had Gorlin syndrome. RESULTS Karyotypically, the following abnormal chromosomal complement was detected in the 2-week-old male's CF: 46,XY,del(9)(q22q34)[15]. FISH studies revealed homozygous loss of the PTCH1 locus in the cytogenetically analyzed CF and in the CF arising in the 13-week-old male. Heterozygous loss of this locus was identified in the remaining CF from the 2-month-old female. A mutational mechanism other than deletion may be responsible for PTCH1 inactivation on the other locus in this latter patient. Conventional cytogenetic and FISH studies of the peripheral blood sample from the 2-week-old male were normal. CONCLUSION These data support a tumor suppressor gene role for PTCH1 in nonsyndromic or sporadic CFs.
Collapse
Affiliation(s)
- David Scanlan
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE 68198-8135, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
130
|
Sharma K, Rohlicek C, Cecere R, Tchervenkov CI. Malignant arrhythmias secondary to a cardiac fibroma requiring transplantation in a teenager. J Heart Lung Transplant 2007; 26:639-41. [PMID: 17543790 DOI: 10.1016/j.healun.2007.03.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2006] [Revised: 03/01/2007] [Accepted: 03/09/2007] [Indexed: 10/23/2022] Open
Abstract
We report a case of a 13-year old girl with a diagnosis of cardiac fibroma who was followed for a decade. Although she was predominantly asymptomatic over this time period, she eventually developed significant ventricular arrhythmias. The arrhythmias were originally treated with anti-arrhythmic medications along with an automatic internal cardioverter-defibrillator. However, a nearly fatal event prompted a cardiac transplantation. This represents a unique case of a patient with cardiac fibroma who was bridged to transplantation with an internal cardioverter-defibrillator.
Collapse
Affiliation(s)
- Kapil Sharma
- Division of Cardiothoracic Surgery, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada.
| | | | | | | |
Collapse
|
131
|
Neragi-Miandoab S, Kim J, Vlahakes GJ. Malignant tumours of the heart: a review of tumour type, diagnosis and therapy. Clin Oncol (R Coll Radiol) 2007; 19:748-56. [PMID: 17693068 DOI: 10.1016/j.clon.2007.06.009] [Citation(s) in RCA: 111] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2006] [Revised: 05/10/2007] [Accepted: 06/15/2007] [Indexed: 01/10/2023]
Abstract
Primary cardiac neoplasms are rare and occur less commonly than metastatic disease of the heart. In this overview, current published studies concerning malignant neoplasms of the heart are reviewed, together with some insights into their aetiology, diagnosis and management. We searched medline using the subject 'cardiac neoplasms'. We selected about 110 articles from between 1973 and 2006, of which 76 sources were used to complete the review. Sarcomas are the most common cardiac tumours and include myxosarcoma, liposarcoma, angiosarcoma, fibrosarcoma, leiomyosarcoma, osteosarcoma, synovial sarcoma, rhabdomyosarcoma, neurofibrosarcoma, malignant fibrous histiocytoma and undifferentiated sarcoma. The classic symptoms of cardiac tumours are intracardiac obstruction, signs of systemic embolisation, and systemic or constitutional symptoms. However, serious complications including stroke, myocardial infarction and even sudden death from arrhythmia may be the first signs of a tumour. Echocardiography and angiography are essential diagnostic tools for evaluating cardiac neoplasms. Computed tomography and magnetic resonance imaging studies have improved the diagnostic approach in recent decades. Successful treatment for benign cardiac tumours is usually achieved by surgical resection. Unfortunately, resection of the tumour is not always feasible. The prognosis after surgery is usually excellent in the case of benign tumours, but the prognosis of malignant tumours remains dismal. In conclusion, there are limited published data concerning cardiac neoplasms. Therefore, a high level of suspicion is required for early diagnosis. Surgery is the cornerstone of therapy. However, a multi-treatment approach, including chemotherapy, radiation as well as evolving approaches such as gene therapy, might provide a better palliative and curative result.
Collapse
Affiliation(s)
- S Neragi-Miandoab
- Department of Surgery, University Hospitals of Cleveland, Case Western Reserve University, School of Medicine, Cleveland, OH 44106, USA.
| | | | | |
Collapse
|
132
|
Mühler MR, Rake A, Schwabe M, Schmidt S, Kivelitz D, Chaoui R, Hamm B. Value of fetal cerebral MRI in sonographically proven cardiac rhabdomyoma. Pediatr Radiol 2007; 37:467-74. [PMID: 17357805 DOI: 10.1007/s00247-007-0436-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2007] [Revised: 02/16/2007] [Accepted: 02/18/2007] [Indexed: 11/26/2022]
Abstract
BACKGROUND Tuberous sclerosis complex (TSC) is an autosomal dominant phakomatosis associated with intracardiac rhabdomyomas. OBJECTIVE The aim of our study was to examine the value of cerebral MRI in diagnosing TSC in fetuses with intracardiac rhabdomyomas, applying the TSC Consensus Conference (TSCCC) criteria. MATERIALS AND METHODS In a prospective manner six consecutive fetuses with cardiac rhabdomyomas (21-34 weeks' gestation) underwent cerebral MRI. The MRI results were correlated with clinical follow-up at 10-34 months after birth, histology, and genetic data. RESULTS In five of the six fetuses the diagnosis of TSC was established. In two of five fetuses MRI demonstrated cerebral manifestations of TSC that correlated well with severe epilepsy manifesting during the follow-up period. In another two of five fetuses MRI as well as clinical follow-up were normal. One of five pregnancies was terminated and histology demonstrated microscopically small subependymal nodules not demonstrated by MRI. CONCLUSION The results of our study agree with the available literature that fetal MRI is sufficient for the detection of cerebral lesions in TSC and should be better promoted. The TSCCC criteria can also be applied to fetal MRI.
Collapse
Affiliation(s)
- Matthias R Mühler
- Department of Radiology, Charité Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117, Berlin, Germany.
| | | | | | | | | | | | | |
Collapse
|
133
|
Abstract
This article reviews the pathological classification of cardiac and pericardial neoplasms, the incidence of the various tumor types, and the role of CT and MRI, including their major differences and clinical impact on patient management.
Collapse
Affiliation(s)
- Edwin J R van Beek
- Department of Radiology, Carver College of Medicine, University of Iowa, Iowa City, Iowa 52242-1077, USA.
| | | | | | | |
Collapse
|
134
|
Altbach MI, Squire SW, Kudithipudi V, Castellano L, Sorrell VL. Cardiac MRI is Complementary to Echocardiography in the Assessment of Cardiac Masses. Echocardiography 2007; 24:286-300. [PMID: 17313646 DOI: 10.1111/j.1540-8175.2007.00392.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Despite the fact that the incidence of cardiac tumors is low, the prompt evaluation and adequate intervention of these is highly important. Although most tumors of the heart are considered histologically benign, there are significant risks associated with these "benign" tumors. These are associated with significant morbidity and mortality due to obstruction of blood flow, alterations of conduction, propagation of arrhythmias, and thromboembolism, depending on their size, location, and nature. With the advent of noninvasive imaging modalities--traditionally echocardiography; but more recently using cross-sectional imaging with cardiac computed tomography and magnetic resonance imaging--cardiac tumors can be optimally assessed providing a greater opportunity for curative treatments by cardiothoracic surgery.
Collapse
Affiliation(s)
- Maria I Altbach
- Department of Radiology, Section of Cardiology, University of Arizona, Sarver Heart Center, Tucson, Arizona 85724, USA
| | | | | | | | | |
Collapse
|
135
|
Uzun O, Wilson DG, Vujanic GM, Parsons JM, De Giovanni JV. Cardiac tumours in children. Orphanet J Rare Dis 2007; 2:11. [PMID: 17331235 PMCID: PMC3225855 DOI: 10.1186/1750-1172-2-11] [Citation(s) in RCA: 159] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2006] [Accepted: 03/01/2007] [Indexed: 01/12/2023] Open
Abstract
Cardiac tumours are benign or malignant neoplasms arising primarily in the inner lining, muscle layer, or the surrounding pericardium of the heart. They can be primary or metastatic. Primary cardiac tumours are rare in paediatric practice with a prevalence of 0.0017 to 0.28 in autopsy series. In contrast, the incidence of cardiac tumours during foetal life has been reported to be approximately 0.14%. The vast majority of primary cardiac tumours in children are benign, whilst approximately 10% are malignant. Secondary malignant tumours are 10-20 times more prevalent than primary malignant tumours. Rhabdomyoma is the most common cardiac tumour during foetal life and childhood. It accounts for more than 60% of all primary cardiac tumours. The frequency and type of cardiac tumours in adults differ from those in children with 75% being benign and 25% being malignant. Myxomas are the most common primary tumours in adults constituting 40% of benign tumours. Sarcomas make up 75% of malignant cardiac masses. Echocardiography, Computing Tomography (CT) and Magnetic Resonance Imaging (MRI) of the heart are the main non-invasive diagnostic tools. Cardiac catheterisation is seldom necessary. Tumour biopsy with histological assessment remains the gold standard for confirmation of the diagnosis. Surgical resection of primary cardiac tumours should be considered to relieve symptoms and mechanical obstruction to blood flow. The outcome of surgical resection in symptomatic, non-myxomatous benign cardiac tumours is favourable. Patients with primary cardiac malignancies may benefit from palliative surgery but this approach should not be recommended for patients with metastatic cardiac tumours. Surgery, chemotherapy and radiotherapy may prolong survival. The prognosis for malignant primary cardiac tumours is generally extremely poor.
Collapse
Affiliation(s)
- Orhan Uzun
- Consultant Paediatric Cardiologist, Department of Paediatric Cardiology, University Hospital Of Wales, Heath Park Cardiff, CF14 4XW, Wales, UK
| | - Dirk G Wilson
- Consultant Paediatric Cardiologist, Department of Paediatric Cardiology, University Hospital Of Wales, Heath Park Cardiff, CF14 4XW, Wales, UK
| | - Gordon M Vujanic
- Consultant Senior Lecturer in Paediatric Pathology, School of Medicine, Cardiff University, Heath Park, Cardiff CF14 4XW, Wales, UK
| | - Jonathan M Parsons
- Consultant Paediatric Cardiologist, Yorkshire Heart Centre, Department Of Paediatric Cardiology, Leeds, UK
| | - Joseph V De Giovanni
- Consultant Paediatric Cardiologist. Birmingham Children's Hospital, Birmingham, UK
| |
Collapse
|
136
|
Kellenberger CJ, Yoo SJ, Büchel ERV. Cardiovascular MR imaging in neonates and infants with congenital heart disease. Radiographics 2007; 27:5-18. [PMID: 17234995 DOI: 10.1148/rg.271065027] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Cardiovascular magnetic resonance (MR) imaging has become an important alternative to echocardiography and angiocardiography in the evaluation of patients with congenital heart disease (CHD). It is increasingly being used in neonates and infants for the initial investigation of CHD or as follow-up after surgery or catheter-guided intervention. Specific indications for cardiovascular MR imaging in neonates and infants include investigation of the thoracic vasculature, quantification of the ventricular volumes, and evaluation of primary cardiac tumors. To obtain good-quality MR images in neonates and infants, it is essential to adjust the technical parameters of the pulse sequences to the small size and fast heart rates of the patients. Various MR imaging techniques are available that are effective in demonstrating the complex morphologic features of the cardiovascular system and that provide additional functional and hemodynamic information. The information provided by cardiovascular MR imaging is useful for treatment planning and, in many cases, may obviate potentially harmful cardiac catheterization.
Collapse
Affiliation(s)
- Christian J Kellenberger
- Department of Diagnostic Imaging, University Children's Hospital, Stein-wiesstrasse 75, CH 8032 Zürich, Switzerland.
| | | | | |
Collapse
|
137
|
Thomas-de-Montpréville V, Nottin R, Dulmet E, Serraf A. Heart tumors in children and adults: clinicopathological study of 59 patients from a surgical center. Cardiovasc Pathol 2007; 16:22-8. [PMID: 17218211 DOI: 10.1016/j.carpath.2006.05.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2006] [Revised: 05/05/2006] [Accepted: 05/31/2006] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Heart tumors are rare lesions with variegated histological types. Their clinicopathological features could be more comprehensively categorized. METHODS This is a 19-year retrospective study of 17 infants/toddlers (<2 years of age) and 42 patients aged between 14 and 79 years (mean = 51.5) in a surgical center. RESULTS Congenital tumors (n = 17; 29%), including rhabdomyomas (n = 9), ventricular fibromas (n = 6), and hemangiomas (n = 1), required surgery mainly because of mass effect. Familial myofibromatosis was the only embolic congenital lesion. Acquired benign tumors (n = 28; 47%) included myxomas (n = 21), fibroelastomas (n = 3), myofibroblastic inflammatory tumors (n = 2), and lipomas (n = 2). Eight (29%) were revealed by systemic embolization. These benign noncongenital tumors were all treated by complete resection, except for an incompletely resected lipoma of the mitral valve. Postoperative arrhythmia (n = 1) and pericardial effusion (n = 3) were the only complications. Primary sarcomas (n = 8; 14%) were mostly vascular tumors (five of eight), and patients with high-grade tumors had a mean survival of 15 months (n = 5). Cardiac metastases (n = 6; 10%) were from carcinomas (n = 3) or sarcomas (n = 3); apart from a necrotic metastasis, all patients died (mean survival of 6 months). CONCLUSIONS This study shows that, regardless of patients' age, heart tumors can be classified as: (a) congenital lesions, which are spontaneously nonprogressive or regressive lesions possibly requiring surgery mainly because of mass effect; (b) acquired benign tumors, which are lesions requiring surgery often because of embolization risk; and (c) primary and secondary malignant tumors, which are lesions with globally poor prognosis but with some indications for resection.
Collapse
|
138
|
Ilina MV, Jaeggi ET, Lee KJ. Neonatal rhabdomyoma causing right ventricular inflow obstruction with duct-dependent pulmonary blood flow: Successful stenting of PDA. Catheter Cardiovasc Interv 2007; 69:881-5. [PMID: 17436271 DOI: 10.1002/ccd.21064] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We describe an infant with the antenatal diagnosis of a large intracardiac rhabdomyoma causing tricuspid inflow obstruction. Postnatal cyanosis and arterial hypoxemia prompted commencement of intravenous prostaglandin E1 with immediate improvement in saturations. Clinical and genetic testing confirmed diagnosis of tuberous sclerosis. To secure ductal patency, two tandem coronary stents were implanted via an antegrade approach. Several episodes of long RP atrio-ventricular re-entrant tachycardia were observed. At 7(1/2) months of age, the tumor was no longer obstructive to tricuspid inflow, ductal flow was highly restrictive and there was no recurrence of supraventricular tachycardia.
Collapse
Affiliation(s)
- Maria V Ilina
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto School of Medicine, Toronto, Ontario, Canada
| | | | | |
Collapse
|
139
|
Motto A, Ballo P, Bocelli A, Gramenzi S, de Martino M. Echocardiographic History of an Asymptomatic Congenital Cardiac Tumor. Circulation 2006; 114:e591-3. [PMID: 17116773 DOI: 10.1161/circulationaha.106.637116] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Andrea Motto
- Cardiology Operative Unit, S. Andrea Hospital, La Spezia, Italy
| | | | | | | | | |
Collapse
|
140
|
Dulac Y, Plat G, Taktak A, Bassil R, Zabalawi A, Paranon S, Rumeau P, Marcoux MO, Acar P. Volumineuse tumeur cardiaque révélée par un trouble du rythme ventriculaire chez un nourrisson de 18 mois. Arch Pediatr 2006; 13:1416-9. [PMID: 16928432 DOI: 10.1016/j.arcped.2006.06.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2005] [Accepted: 06/28/2006] [Indexed: 10/24/2022]
Abstract
Cardiac tumors are rare in childhood and can be revealed by arrhythmias. We report the observation of an 18-month-old infant who had an episode of ventricular tachycardia (VT) which resulted in a large intramyocardic tumour diagnosis evocating a left ventricular fibroma. A treatment by amiodarone allowed a stable reduction of the VT. The presence of an intracardiac obstruction or uncontrollable arrhythmias would lead to a surgical resection.
Collapse
Affiliation(s)
- Y Dulac
- Servie de cardiologie pédiatrique, hôpital des Enfants, 330, avenue de Grande-Bretagne, 31059 Toulouse cedex 09, France.
| | | | | | | | | | | | | | | | | |
Collapse
|
141
|
Atallah J, Robertson M, Rebeyka IM, Dyck J, Noga ML. Antenatal diagnosis and successful surgical removal of a large right ventricular fibroma. Pediatr Cardiol 2006; 27:493-6. [PMID: 16835803 DOI: 10.1007/s00246-006-1260-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2005] [Accepted: 03/13/2006] [Indexed: 11/26/2022]
Abstract
Congenital cardiac tumors are very rare and fibromas are the second most common type. Fibromas are benign tumors, but they have potentially serious complications. Their antenatal diagnosis is infrequently reported in the literature, and the management of these tumors is a source of controversy. We report the case of a rare form of right ventricular free wall fibroma. Antenatal diagnosis was made at 36 weeks of gestation, with subsequent successful resection at 2 weeks of age. A brief review of the literature focuses on the diagnostic approach and the clinical and surgical management of congenital cardiac fibromas.
Collapse
Affiliation(s)
- Joseph Atallah
- Division of Pediatric Cardiology, University of Alberta Hospitals, Stollery Children's Hospital, Edmonton, Alberta, Canada T6G 2B7.
| | | | | | | | | |
Collapse
|
142
|
George KM, Przygodzki RM, Jonas RA, Di Russo GB. Resection of an obstructive neonatal cardiac myxoma of the infundibulum. Pediatr Cardiol 2006; 27:369-71. [PMID: 16565904 DOI: 10.1007/s00246-005-1216-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Myxoma, the most common primary cardiac tumor in adults, is rare in neonates. We describe a myxoma arising from the infundibulum of the right ventricle causing significant outflow tract obstruction in an otherwise normal newborn. Serial echocardiograms revealed an increasing gradient across the right ventricular outflow tract prompting surgery. The patient underwent successful excision of the myxoma with an uneventful recovery.
Collapse
Affiliation(s)
- K M George
- Department of Cardiovascular Surgery, Children's National Medical Center, 111 Michigan Avenue, NW, Washington, DC 20010-2970, USA
| | | | | | | |
Collapse
|
143
|
Ikemba CM, Eidem BW, Dimas VV, O'Day MP, Fraser CD. Fetal Rhabdomyoma Causing Postnatal Critical Left Ventricular Outflow Tract Obstruction. Ann Thorac Surg 2005; 80:1529. [PMID: 16181915 DOI: 10.1016/j.athoracsur.2003.10.095] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/28/2003] [Indexed: 11/25/2022]
Affiliation(s)
- Catherine M Ikemba
- Division of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA.
| | | | | | | | | |
Collapse
|
144
|
Ménard C, Hagège AA, Agbulut O, Barro M, Morichetti MC, Brasselet C, Bel A, Messas E, Bissery A, Bruneval P, Desnos M, Pucéat M, Menasché P. Transplantation of cardiac-committed mouse embryonic stem cells to infarcted sheep myocardium: a preclinical study. Lancet 2005; 366:1005-12. [PMID: 16168783 DOI: 10.1016/s0140-6736(05)67380-1] [Citation(s) in RCA: 224] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Heart failure develops after myocardial infarction and is a major cause of morbidity and mortality. The ability to direct differentiation of embryonic stem cells (ESC) towards a cardiomyogenic phenotype makes them an attractive therapeutic option for cardiac repair, but species-specific and individual-specific immunological imprinting remains a hurdle. Our aim was to ascertain whether the purported immune privilege of ESC allows for their cross-species engraftment in a clinically relevant large-animal model. METHODS We studied engraftment and differentiation of cardiac-committed mouse ESC in 18 sheep in which a myocardial infarction had been induced; nine controls received medium and nine sheep (five of which were immunosuppressed) received ESC. The gain in myocardial function was measured by echocardiography 1 month after cell transplantation. FINDINGS Cardiac-committed murine ESC engrafted in infarcted myocardium of immunosuppressed and immunocompetent sheep, and differentiated into mature cardiomyocytes that expressed connexins. Colonisation of the scar area by ESC was accompanied by a functional benefit of the damaged myocardium. Left-ventricular ejection fraction deteriorated in the control group by a median of 9.9% (range -20 to 0.3) relative to baseline (p=0.011) whereas in the treated group it improved by 6.6% (-5.7 to 50.8; comparison between groups p=0.002). INTERPRETATION These findings obtained in a clinically relevant large-animal model of heart failure strengthen the potential therapeutic use of ESC to regenerate the severely dysfunctional myocardium and bring additional evidence for an immune privilege of these cells.
Collapse
Affiliation(s)
- Claudine Ménard
- Centre National de la Recherche Scientifique, FRE2593, Centre de Recherche de Biochimie Macromoléculaire, Montpellier, France
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
145
|
Hicks J, Mierau GW. The spectrum of pediatric tumors in infancy, childhood, and adolescence: a comprehensive review with emphasis on special techniques in diagnosis. Ultrastruct Pathol 2005; 29:175-202. [PMID: 16036874 DOI: 10.1080/01913120590951185] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The spectrum of pediatric tumors varies considerably, from those derived from blastemal cells in various organ systems to proliferations of soft tissue supporting cells to hamartomatous processes that mimic malignant tumors. Small round cell tumors are often undifferentiated or poorly differentiated, making it difficult sometimes to provide a definitive diagnosis. Both benign and malignant tumors require a coordinated method for diagnosis, and need a comprehensive evaluation to provide the most appropriate diagnosis for designing therapy and predicting prognosis. Pediatric tumors require the integration of routine histopathologic examination with histochemical, immunocytochemical, ultrastructural, cytogenetic, and diagnostic molecular pathology techniques. This review provides updated guidelines with respect to the application of these special techniques in this rapidly evolving diagnostic arena.
Collapse
Affiliation(s)
- John Hicks
- Department of Pathology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas 77030, USA.
| | | |
Collapse
|
146
|
Mackie AS, Kozakewich HPW, Geva T, Perez-Atayde AR, Mulliken JB. Vascular tumors of the heart in infants and children: case series and review of the literature. Pediatr Cardiol 2005; 26:344-9. [PMID: 15549621 DOI: 10.1007/s00246-004-0717-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Primary tumors of the heart are rare in children, of which vascular tumors comprise a small subgroup. We present the clinical, histopathologic, and imaging findings in six children with vascular tumors of the heart and review the findings of 36 previously published cases. We observed three intramuscular hemangiomas of the small-vessel type in older children, two congenital hemangiomas in infants, and one malignant polymorphous hemangioendothelioma. Intramuscular hemangiomas did not respond to corticosteroid and were biologically distinct from the congenital hemangiomas, both of which exhibited regression with pharmacotherapy. Age at diagnosis appears to predict histologic type, tumor location, and clinical presentation.
Collapse
Affiliation(s)
- A S Mackie
- Department of Cardiology, Children's Hospital Boston, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
| | | | | | | | | |
Collapse
|
147
|
Padalino MA, Basso C, Milanesi O, Vida VL, Moreolo GS, Thiene G, Stellin G. Surgically treated primary cardiac tumors in early infancy and childhood. J Thorac Cardiovasc Surg 2005; 129:1358-63. [PMID: 15942578 DOI: 10.1016/j.jtcvs.2004.10.020] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Primary heart tumors in childhood are rare and mostly benign. Surgical treatment is advocated when symptoms or hemodynamic impairment is present. MATERIALS AND METHODS Between 1986 and 2003, 8 children (3 males and 5 females, age ranging 5 days to 6.7 years, median 78 days) with a clinical diagnosis of cardiac mass were treated with surgery. Diagnosis was made by prenatal echocardiography in 3 patients and by 2-dimensional Doppler echocardiography in 5 patients. RESULTS Complete surgical excision of the cardiac mass was feasible in all but 1 patient who underwent orthotopic heart transplantation. Surgical pathology examination revealed myxoma in 2 patients, fibroma in 2 patients, rhabdomyoma in 2 patients (multiple in 1), hamartoma in 1 patient, and teratoma in 1 patient. One patient died of cerebral malignancy 38 months after cardiac transplantation. At a mean follow-up of 69.2 months (range 3-190 months), all the remaining patients are asymptomatic, with good ventricular function on 2-dimensional echocardiography and no signs of residual or recurrent tumor. CONCLUSION Surgical excision of obstructive cardiac tumors in childhood is safely feasible. Heart transplantation may represent the only therapeutic option when the tumor extensively invades the ventricular walls. Although 2-dimensional echocardiography remains a reliable diagnostic tool, a definite diagnosis of tumor histotype requires a thorough histopathologic characterization.
Collapse
Affiliation(s)
- Massimo A Padalino
- Division of Pediatric Cardiovascular Surgery, University of Padova Medical School, Padova, Italy
| | | | | | | | | | | | | |
Collapse
|
148
|
Kagan KO, Schmidt M, Kuhn U, Kimmig R. Ventricular outflow obstruction, valve aplasia, bradyarrhythmia, pulmonary hypoplasia and non-immune fetal hydrops because of a large rhabdomyoma in a case of unknown tuberous sclerosis: a prenatal diagnosed cardiac rhabdomyoma with multiple symptoms. BJOG 2005; 111:1478-80. [PMID: 15663143 DOI: 10.1111/j.1471-0528.2004.00271.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- K O Kagan
- Department of Obstetrics and Gynaecology, University of Essen, Germany
| | | | | | | |
Collapse
|
149
|
Restrepo CS, Largoza A, Lemos DF, Diethelm L, Koshy P, Castillo P, Gomez R, Moncada R, Pandit M. CT and MR imaging findings of benign cardiac tumors. Curr Probl Diagn Radiol 2005; 34:12-21. [PMID: 15644859 DOI: 10.1067/j.cpradiol.2004.10.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This imaging review describes the appearance of benign cardiac tumors on CT and MRI. Although rare, benign tumors outnumber their primary malignant counterparts three to one. Since mortality varies directly with invasion, identifying the neoplasm at an early stage helps focus treatment, especially in benign cases, which generally respond well to surgical resection. In adults and children, myxomas and rhabdomyomas, respectively, represent the most common benign tumors, which can be grouped into tissue-specific subtypes, such as rhabdomyomas, fibromas, lipomas, teratomas, etc. Besides their variable prevalence in particular age groups, these tumors also differ with regard to their gender predilection, location, and number. For example, myxomas appear predominantly in women and generally as a solitary mass in the left or right atrium, whereas rhabdomyomas present equally in boys and girls and chiefly as multiple masses in the ventricles. Despite their differences, however, both types share an association with heritable syndromes like the Carney complex for myxomas and tuberous sclerosis for rhabdomyomas. As with all cardiac tumors, echocardiographic findings usually suggest the initial diagnosis but cross-sectional imaging with CT and MRI can help resolve diagnostically challenging cases. For example, with its direct multiplanar capability, excellent contrast resolution, and large field of view, MRI permits a detailed examination of the entire mediastinum, helping to rule out an equivocal mass on echocardiography. Through dynamic techniques, MRI, in addition to morphologic characterization, can depict the pathophysiological effects of these tumors, for instance, with regard to myocardial contraction, valvular function, or blood flow.
Collapse
Affiliation(s)
- Carlos S Restrepo
- Department of Radiology, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
150
|
Parry AJ, Carroll S, Lotto A, Wolf A, Tometzki AJP, Soothill P. Median sternotomy as an exit procedure in a child with massive pericardial tumor. J Pediatr Surg 2004; 39:1408-10. [PMID: 15359400 DOI: 10.1016/j.jpedsurg.2004.05.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Fetuses can survive with complete airway obstruction caused by placental gas exchange until birth when full ventilatory function is required. The authors present a case in which prenatal scans suggested that adequate ventilation would not be achievable because of the presence of an intrathoracic tumor. An EXIT procedure (exutero intrapartum treatment) was therefore performed, which permitted sufficient lung expansion for adequate ventilation.
Collapse
Affiliation(s)
- Andrew J Parry
- Department of Paediatric Cardiac Surgery, Bristol Royal Hospital for Children, Bristol, UK
| | | | | | | | | | | |
Collapse
|