151
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Tomizawa Y, Endo M, Nishida H, Kikuchi C, Koyanagi H. Reconstruction of the left ventricle in a patient with cardiac hemangioma at the apex. Ann Thorac Surg 2001; 71:2032-4. [PMID: 11426796 DOI: 10.1016/s0003-4975(00)02500-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Cardiac hemangiomas in the left ventricle are extremely rare. A 34-year-old woman, without symptoms, with a diagnosis of cardiac tumor at the apex of the left ventricle was referred to us. The tumor was surgically resected, and the diagnosis was hemangioma. The Jatene technique, originally introduced for left ventricular aneurysmectomy was excellent for repair after resection of a cardiac tumor at the apex.
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Affiliation(s)
- Y Tomizawa
- Department of Cardiovascular Surgery, Tokyo Women's Medical University, Japan.
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152
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Wu JR, Chiu CC, Lin YT, Dai ZK, Lin HJ. Cyanosis caused by a huge obstructive right ventricular fibroma. JAPANESE HEART JOURNAL 2000; 41:239-43. [PMID: 10850540 DOI: 10.1536/jhj.41.239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Cardiac fibromas are rare lesions which occur more often in infants and children than in adults. These tumors are benign proliferations of connective tissue most often found in the left ventricular myocardium or septum. In an 8-month-old infant with cyanosis and progressive exertional dyspnea, a huge cardiac tumor obstructing the right ventricular outflow tract (RVOT) was diagnosed by means of 2-dimensional echocardiography and cardiac catheterization. At surgery, a whitish gray solitary tumor measuring 5.0 x 4.5 cm could be well visualized. It was nearly totally resected, and the RVOT was reconstructed with an Equine pericardial patch. Histologic examination classified the tumor as a fibroma. Although surgical mortality in cardiac fibroma with RVOT obstruction is extremely high, early diagnosis and prompt excision of the tumor is mandatory in relieving its dangerous symptoms.
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Affiliation(s)
- J R Wu
- Department of Pediatrics, Kaohsiung Medical University, Taiwan
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153
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Jiménez Casso S, Benito Bartolomé F, Sánchez Fernández-Bernal C. Rabdomiomas cardíacos en la esclerosis tuberosa: manifestaciones clínicas y evolución de 18 casos diagnosticados en la infancia. An Pediatr (Barc) 2000. [DOI: 10.1016/s1695-4033(00)77288-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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154
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Mah CS, Vaughan CJ, Basson CT. Advances in the molecular genetics of congenital structural heart disease. GENETIC TESTING 1999; 3:157-72. [PMID: 10464664 DOI: 10.1089/gte.1999.3.157] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Molecular genetic analyses have generated significant advances in our understanding of congenital heart disease. Techniques of genetic mapping with polymorphic microsatellites and fluorescence in situ hybridization (FISH) have provided informative tools for localization and identification of disease genes. Some cardiovascular diseases have proven to result from single gene defects. Others relate to more complex etiologies involving several genes and their interactions. Elucidation of the molecular genetic etiologies of congenital heart disease prompts consideration of DNA testing for cardiac disorders. Future integration of these diagnostic modalities with improved treatments may ultimately decrease morbidity and mortality from congenital heart diseases.
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Affiliation(s)
- C S Mah
- Department of Medicine, Weill Medical College of Cornell University, New York Hospital, NY 10021, USA
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155
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Phoon CK, Divekar A, Rutkowski M. Pediatric echocardiography: applications and limitations. CURRENT PROBLEMS IN PEDIATRICS 1999; 29:157-85. [PMID: 10410851 DOI: 10.1016/s0045-9380(99)80034-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Echocardiography is an extraordinarily useful imaging technique in fetuses, infants, children, and adolescents. Recent technologic innovations have expanded its versatility in the pediatric population. However, limited societal resources, limitations inherent to ultrasound imaging, and numerous imaging options even within the field of pediatric echocardiography necessitate the discriminate and thoughtful use of echocardiography in children. The clinical assessment remains a critical prelude to echocardiographic examination of the pediatric cardiovascular system.
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Affiliation(s)
- C K Phoon
- Pediatric Echocardiography Laboratory, New York University School of Medicine and Medical Center, New York, USA
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156
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Abstract
We reviewed 22 cases of primary pediatric cardiac tumors followed at our institution from January 1981 through November 1997, analyzing them by subtype, age and manner of presentation, location, associated findings, interventions, and clinical course. Rhabdomyomas were the most common (11), followed by intrapericardial teratomas (2), myxomas (1), fibromas (1), hemangiomas (1), mesotheliomas (1), and rhabdomyosarcomas (1), with 4 undetermined tumors. The majority (77%) of tumors were diagnosed before the age of one year, including six prenatally. The most common presentations were murmurs (5), arrhythmias (5), and abnormal screening fetal ultrasound examinations (4). Tumors were located most frequently in the right ventricle (13) and left ventricle (7), with multiple tumors being present in 10 cases. Eight patients (36%) had associated arrhythmias or conduction abnormalities, and of the 11 patients with rhabdomyomas, tuberous sclerosis was diagnosed in 8. Eight patients underwent cardiac catheterization, including two for electrophysiologic study with radiofrequency ablation, and seven patients had complete or partial tumor resection. The follow-up period ranged from 2 months to 15 years, and there were 3 tumor-related deaths. Therefore, despite the benign histology of most primary pediatric cardiac tumors, there may be significant associated morbidity and occasional mortality. As echocardiographic techniques such as fetal ultrasonography have continued to improve, however, these cardiac tumors have increasingly been detected early before significant symptoms develop.
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Affiliation(s)
- D Sallee
- Department of Pediatrics, Rainbow Babies and Childrens Hospital, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
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157
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Abstract
Tuberous sclerosis complex (TSC) is an autosomal-dominant neurocutaneous disorder with a high spontaneous mutation rate. Understanding of this disorder has greatly increased in recent years. Two chromosomal loci can produce the TSC phenotype: 9q34 and 16p13. These appear to code for proteins that have a tumor suppressor function. TSC results in hamartomas that affect various organ systems, most commonly brain, skin, heart, and kidney. Previously thought to consist of intractable seizures, facial angiofibromas, and dementia, increasing numbers of persons with less severe involvement have been identified. Diagnostic criteria, various types of lesions, and medical management are reviewed.
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Affiliation(s)
- D N Franz
- Department of Pediatrics, University of Cincinnati College of Medicine, OH, USA
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158
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Abstract
Primary benign intracardiac tumours in the infant period are rare. We report a case of a cardiac osteoma detected at 17 weeks of gestation. Ultrasonographically, it appeared as a calcified mass with a sharp margin and was associated with hypoplastic right ventricle. The gross and histological findings are presented.
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Affiliation(s)
- T Y Fung
- Department of Obstetrics and Gynaecology, Prince of Wales Hospital, Chinese University of Hong Kong, China.
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159
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Beghetti M, Gow RM, Haney I, Mawson J, Williams WG, Freedom RM. Pediatric primary benign cardiac tumors: a 15-year review. Am Heart J 1997; 134:1107-14. [PMID: 9424072 DOI: 10.1016/s0002-8703(97)70032-2] [Citation(s) in RCA: 231] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
An increase in the incidence of primary cardiac tumors has been reported since the development or enhancement of noninvasive imaging modalities. We identified 56 children with primary cardiac tumors. Forty-four (78%) children had rhabdomyomas, 6 (11%) fibromas, 1 (2%) pericardial teratoma, 1 (2%) epicardial lipoma, 1 (2%) multicystic hamartoma, and 3 (5%) unspecified tumors. The mean age at diagnosis was 19 +/- 35 months (median 4.7 months, range 0.03 to 204 months), excluding 12 patients who were given the diagnosis before birth. Among 27,640 patients assessed for cardiac disease, the incidence of tumors was 0.06% (1980 to 1984), 0.22% (1985 to 1989), and 0.32% (1990 to 1995). Diagnosis was made in 55 of 56 patients by echocardiography. Catheterization was performed in five patients and magnetic resonance imaging in nine. No tumor-related deaths occurred. Nine patients had surgery because of hemodynamically significant obstruction or arrhythmias. Partial or complete regression occurred in 24 (54%) of 44 patients with rhabdomyomas. Overall, the prognosis was excellent. Individualized surgery allowed early safe treatment of symptomatic tumors.
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Affiliation(s)
- M Beghetti
- Division of Cardiology, The Hospital for Sick Children and the Faculty of Medicine, University of Toronto, Ontario, Canada
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160
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Shore-Lesserson L, Alfarone J. Intracardiac tumor in a neonate causing complete tricuspid valve obstruction. J Cardiothorac Vasc Anesth 1997; 11:487-9. [PMID: 9188001 DOI: 10.1016/s1053-0770(97)90061-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- L Shore-Lesserson
- Department of Anesthesiology, Mount Sinai Medical Center, New York, NY, USA
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161
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Cheitlin MD, Alpert JS, Armstrong WF, Aurigemma GP, Beller GA, Bierman FZ, Davidson TW, Davis JL, Douglas PS, Gillam LD. ACC/AHA Guidelines for the Clinical Application of Echocardiography. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Clinical Application of Echocardiography). Developed in collaboration with the American Society of Echocardiography. Circulation 1997; 95:1686-744. [PMID: 9118558 DOI: 10.1161/01.cir.95.6.1686] [Citation(s) in RCA: 377] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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162
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Gutiérrez-Larraya Aguado F, Galindo Izquierdo A, Olaizola Llodio JI, Sotelo Rodríguez MT, Merino Batres G, Velasco Bayón JM, Pérez Martínez A, de Castro Fernández J, Ordóñez Pérez D, de la Fuente Pérez P. [Fetal cardiac tumors]. Rev Esp Cardiol 1997; 50:187-91. [PMID: 9132879 DOI: 10.1016/s0300-8932(97)73202-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION AND OBJECTIVES Fetal cardiac tumors are rare and have a different histology than in adults: in the fetus, rhabdomyoma is more prevalent, but myxoma has not been described. We report our experience with nine fetuses with prenatally diagnosed primary cardiac tumours. METHODS This is an observational and descriptive study of fetuses investigated because of the prenatal and echographic diagnosis of heart tumors. RESULTS There were nine fetuses with thirteen cardiac masses among more than 700 fetal echocardiographic studies performed by pediatric cardiologists. Histology was available in four of them; three rhabdomyomas and once cavernous hemangioma. In one of the cases, the parents elected to interrupt the pregnancy; three patients died in the neonatal period (two as a direct consequence of the tumors and one due to sepsis) and we have no histological information regarding any of the other five fetuses. The subjects who survived beyond the neonatal period are mostly doing well. However, one developed tuberous sclerosis and another developed a hypoplastic left heart syndrome, perhaps due to the massive restriction of flow across the foramen ovale. The tumors in the other cases were well tolerated and hemodynamic or arrhythmic consequences were minimal of absent. No women with risk factors such as tuberous sclerosis were included in our study. CONCLUSIONS Fetal cardiac tumors are rare and display a different histology. We recommend a conservative approach to treatment.
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163
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Dildy GA, Judd VE, Clark SL. Prospective evaluation of the antenatal incidence and postnatal significance of the fetal echogenic cardiac focus: a case-control study. Am J Obstet Gynecol 1996; 175:1008-12. [PMID: 8885766 DOI: 10.1016/s0002-9378(96)80043-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE We evaluated the antenatal incidence and postnatal significance of echogenic cardiac foci observed during antenatal ultrasonography. STUDY DESIGN During a 4-month period, all women undergoing dating ultrasonography between 16.0 and 24.9 weeks' gestation at one referral center were prospectively evaluated for an echogenic cardiac focus during an apical four-chamber view of the heart. Referrals for maternal or fetal complications were excluded. Postnatal echocardiography was performed for those identified with positive findings. Controls were selected from among normal subjects in the general group for comparison with the study group. RESULTS Five hundred six consecutive fetuses were evaluated at a mean +/- SD gestational age of 20.6 +/- 1.6 weeks. There were 25 (4.9%) fetuses found to have echogenic cardiac focus (left ventricle = 19, right ventricle = 6). Echocardiography was performed between 0.3 and 20.1 weeks postdelivery. After birth, 12 echogenic left ventricle papillary muscles and three echogenic left ventricle chordae were identified; there were no postnatal right ventricle findings. There were no cases of intracardiac tumor or myocardial dysfunction; one neonate had minor structural malformations. There were no significant differences in maternal age, gravidity, parity, gestational age at ultrasonography, gestational age at delivery, or 5-minute Apgar scores. A significant difference was observed in birth weight between the control (n = 50) and study (n = 25) groups (3465 +/- 501 gm vs 3124 +/- 589 gm; p = 0.002). This difference persisted after correcting for gestational age, although all infants in both groups born after 37.0 weeks weighed > 2500 gm. CONCLUSIONS The incidence of echogenic cardiac foci during routine midtrimester ultrasonography is 4.9%. As an isolated finding, the echogenic cardiac focus may be associated with a statistically significant but clinically insignificant decrease in birth weight. Because of these findings, we consider an isolated echogenic cardiac focus in a patient at low risk for cardiac abnormalities a variant of normal, which does not warrant follow-up clinical evaluation.
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Affiliation(s)
- G A Dildy
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, USA
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164
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Pfammatter JP, Iff T, Schüpbach P. Imitation of a chronic recurrent inflammatory illness by a cardiac myxoma. Eur J Pediatr 1996; 155:637-9. [PMID: 8839715 DOI: 10.1007/bf01957143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
UNLABELLED A 10-year-old boy presented with unspecific symptoms and laboratory abnormalities simulating a chronic recurrent inflammatory disorder. Cardiovascular symptoms were absent. After 2 years of intermittent symptoms and persisting laboratory signs of an inflammatory disorder, echocardiographic evaluation revealed a large left atrial tumour. Immediate surgical excision confirmed the diagnosis of a cardiac myxoma and resulted in freedom from symptoms and normalization of laboratory parameters. CONCLUSION A cardiac myxoma can present with unspecific and extracardiac symptoms. It should be considered in the differential diagnosis on unclear chronic inflammatory or chronically recurrent febrile illness suggesting an auto-immune vasculitis or collagen disorder.
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165
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166
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Martin GR. Reply. J Am Coll Cardiol 1996. [DOI: 10.1016/s0735-1097(96)90108-4] [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: 11/17/2022]
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