1
|
Gupta N, Dash P, Marwah A. Fetal cardiac teratoma and pericardiocentesis: A case report. Prenat Diagn 2024; 44:876-878. [PMID: 38752660 DOI: 10.1002/pd.6590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 04/10/2024] [Accepted: 05/01/2024] [Indexed: 06/17/2024]
Abstract
Fetal pericardial teratomas are rare. They present with pericardial effusion and hydrops. The definitive management is postnatal resection of the tumor. The exact antenatal management is not known due to its rarity. We present a case of fetal pericardial teratoma with pericardial tamponade. Pericardiocentesis performed at 31 weeks significantly relieved the venous compression, leading to resolution of hydrops and prolonging the gestational age for the definitive management.
Collapse
Affiliation(s)
- Neha Gupta
- Fetal Medicine Department, Kailash Hospital, Sector 27, Noida, India
| | - Pratima Dash
- Fetal Medicine Department, Kailash Hospital, Sector 27, Noida, India
| | | |
Collapse
|
2
|
Camargo FM, Brizot MDL, Francisco RPV, de Carvalho WB, Ikari NM, Peres SV, Lopes MAB, Lopes LM. Perinatal Results and Long-Term Follow-Up of Fetal Cardiac Tumors: A 30-Year Historical Cohort Study. Arq Bras Cardiol 2024; 121:e20220469. [PMID: 38536996 PMCID: PMC11081142 DOI: 10.36660/abc.20220469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 05/28/2023] [Accepted: 10/04/2023] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND This was a 30-year retrospective cohort study that approximates closely to the natural history of cardiac tumors diagnosed in the fetus, since there was no case of pregnancy interruption. OBJECTIVE To assess morbidity and mortality in the perinatal period and at long term in fetuses diagnosed with cardiac tumor. Our secondary objective was to assess the evaluating factors of perinatal and postnatal results. METHODS This was a retrospective cohort study with 74 pregnant women with an echocardiographic diagnosis of fetal cardiac tumor at two referral centers between May 1991 and November 2021. A descriptive analysis was performed, and data were expressed as absolute (n) and relative (%) frequencies, median and interquartile range. Fisher's exact test was used to evaluate the association of echocardiographic characteristics and clinical manifestations with perinatal and postnatal results. Global survival was calculated using the Kaplan-Meier method and the curves were compared by the log-rank test. The time of follow-up, calculated in months, corresponded to the time elapsed from hospital discharge to current status (survived/ censoring or death). The level of significance was set at 5% (p<0.05). RESULTS Rhabdomyoma is the most common type of cardiac tumor (85%), with a high morbidity (79.3%) and overall mortality of 17.4%. The presence of fetal hydrops was a predictor of death. CONCLUSION The presence of fetal hydrops had an impact on mortality, and hence is an important factor in counselling and determining the prognosis. Most deaths occurred before hospital discharge.
Collapse
Affiliation(s)
- Fabricio Marcondes Camargo
- Universidade de São PauloFaculdade de MedicinaHospital das ClínicasSão PauloSPBrasilHospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
| | - Maria de Lourdes Brizot
- Universidade de São PauloFaculdade de MedicinaHospital das ClínicasSão PauloSPBrasilHospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
| | - Rossana Pulcineli Vieira Francisco
- Universidade de São PauloFaculdade de MedicinaHospital das ClínicasSão PauloSPBrasilHospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
| | - Werther Brunow de Carvalho
- Universidade de São PauloFaculdade de MedicinaHospital das ClínicasSão PauloSPBrasilInstituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
| | - Nana Miura Ikari
- Universidade de São PauloFaculdade de medicinaSão PauloSPBrasilUniversidade de São Paulo – Faculdade de medicina, São Paulo, SP – Brasil
| | - Stella Verzinhasse Peres
- Universidade de São PauloFaculdade de MedicinaHospital das ClínicasSão PauloSPBrasilHospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
| | - Marco Antônio Borges Lopes
- Universidade de São PauloFaculdade de MedicinaHospital das ClínicasSão PauloSPBrasilHospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
| | - Lilian Maria Lopes
- Cardiologia e Ecocardiografia Fetal Pediátrica e MaternaSão PauloSPBrasilECOKID – Cardiologia e Ecocardiografia Fetal Pediátrica e Materna, São Paulo, SP – Brasil
| |
Collapse
|
3
|
Peng L, Cai Y, Wu J, Ling W, Wu Q, Guo S, Huang B, Jiang C, Weng Z. Prenatal diagnosis and clinical management of cardiac rhabdomyoma: a single-center study. Front Cardiovasc Med 2024; 11:1340271. [PMID: 38433754 PMCID: PMC10904520 DOI: 10.3389/fcvm.2024.1340271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 01/29/2024] [Indexed: 03/05/2024] Open
Abstract
Objective The study aims to assess the ultrasonic features of fetal cardiac rhabdomyoma (CR), track the perinatal outcome and postnatal disease progression, investigate the clinical utility of ultrasound, MRI and tuberous sclerosis complex (TSC) gene analysis in CR evaluation, and offer evidence for determing of fetal CR prognosis. Methods We conducted a retrospective analysis of prenatal ultrasound-diagnosed fetal CR cases in our hospital from June 2011 to June 2022, tracked the perinatal outcomes, regularly followed live infants to analyze cardiac lesion changes and disease progression, and compared the sensitivities of ultrasound, MRI and their combination in the detecting of intracranial sclerosing nodules. Results Our study included 54 fetuses with CR: 32 pregnancies were terminated, 22 were delivered, 35 were diagnosed with TSC, 13 had simple CR without TSC, and in 6 cases, remained unclear whether TSC accompanied the CR due to insufficient evidence. 45 fetuses (83.3%) had multiple lesions, while 9 fetuses (16.7%) presented with a single lesion. Twelve cases had intracardiac complications, all associated with multiple lesions, and these cases exhibited larger maximum tumor diameters than the non-complicated group. Multiple intracardiac lesions were more prevalent in the TSC group than in the simple CR group. However, there was no significant difference in maximum tumor diameter between the two groups. Among 30 fetuses who underwent fetal brain MRI, 23 were eventually diagnosed with TSC, with 11 fetuses showing intracranial sclerosis nodules by ultrasound and 15 by MRI, and the diagnostic consistency was moderate (k = 0.60). Twenty-two fetuses were born and followed up for 6-36 months. CR lesions diminished or disappeared in 18 infants (81.8%), while they remained unchanged in 4 infants (18.2%). Ten out of 12 (83.3%) surviving children diagnosed with TSC developed epilepsy, and 7 (58.3%) had neurodevelopmental dysfunction. Conclusions The majority of CR cases involve multiple lesions, which are a primary risk factor for TSC. Through prenatal ultrasound examination is crucial for assessing fetal CR prognosis. Although ultrasound combined with MRI can detect intracranial sclerosis nodules in TSC fetuses, its sensitivity is limited. TSC gene sequencing is an essential diagnostic method. Simple CR cases without TSC generally have a favorable prognosis.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Caihong Jiang
- Department of Medical Ultrasonics, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Zongjie Weng
- Department of Medical Ultrasonics, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| |
Collapse
|
4
|
Simonini C, Strizek B, Berg C, Gembruch U, Mueller A, Heydweiller A, Geipel A. Fetal teratomas - A retrospective observational single-center study. Prenat Diagn 2020; 41:301-307. [PMID: 33242216 DOI: 10.1002/pd.5872] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/26/2020] [Accepted: 11/23/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Evaluation of course and outcome of pregnancies with prenatally diagnosed fetal teratomas of various locations in a single center between 2002 and 2019. METHODS Retrospective observational single-center study including prenatally suspected or diagnosed fetal teratomas. Focus was put on ultrasound findings during pregnancy. Complications, need for intervention and outcomes were compared according to tumor location. RESULTS 79 cases of fetal teratomas were seen at our center between 2002 and 2019. Most frequent tumor locations were the sacrococcygeal region (59.5%), neck (20.2%) and oropharynx (7.6%). Complications mainly included polyhydramnios and cardiac compromise. Need for intervention during pregnancy was significantly higher in pericardial teratomas. Preterm birth before 37 and early preterm birth before 32 weeks occurred in 72.7% and 29.1%, respectively. Major causes of perinatal death were tumor bleeding in sacrococcygeal teratomas (SCTs) and respiratory failure in cervical and oropharyngeal teratomas. CONCLUSION There is a high need for intervention in pregnancies complicated by fetal teratomas. Pericardiocentesis in pericardial teratomas is often inevitable to reduce the risk of intrauterine demise. Amniotic fluid drainage in associated severe polyhydramnios helps to reduce the risk of preterm birth, a major cause of additional morbidity and mortality. MRI in supplement to prenatal ultrasound is useful in fetal teratomas of the neck and oropharynx in order to plan delivery.
Collapse
Affiliation(s)
- Corinna Simonini
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | - Brigitte Strizek
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | - Christoph Berg
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | - Ulrich Gembruch
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | - Andreas Mueller
- Department of Neonatology and Pediatric Intensive Care, University Hospital Bonn, Bonn, Germany
| | | | - Annegret Geipel
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| |
Collapse
|
5
|
Behram M, Oğlak SC, Acar Z, Sezer S, Bornaun H, Çorbacıoğlu A, Özdemir İ. Fetal cardiac tumors: prenatal diagnosis, management and prognosis in 18 cases. J Turk Ger Gynecol Assoc 2020; 21:255-259. [PMID: 33274615 PMCID: PMC7726467 DOI: 10.4274/jtgga.galenos.2020.2019.0180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective: To evaluate the long-term follow-up of patients with fetal cardiac tumors (FCTs), and to review the literature regarding advances in diagnosis and management of FCTs in the last decade. Material and Methods: In this retrospective study, pregnant women referred to a single center maternal-fetal medicine unit between 2013 and 2018 for advanced ultrasonography, were reviewed. Pediatric cardiology counseling was offered to women whose fetuses had FCTs. All patients were evaluated according to revised diagnostic criteria for tuberous sclerosis complex (TSC). Medical treatment was administered to patients with FCTs ≥30 mm or if they were symptomatic. Everolimus therapy at a dose of 2x0.25 mg twice a week for three months was started in the postnatal period. Results: Out of the 75,312 patients referred 18 (0.024%) were diagnosed with FCTs. Six were referred with fetal arrhythmias and the others were diagnosed with FCTs during routine follow-up. Ten patients (55%) with FCTs were diagnosed with TSC. All tumors were assessed to be rhabdomyoma. Mean tumor diameter in fetuses with TSC was significantly larger than those without TSC (29.8±14.1 mm versus 9.3±4.8 mm, respectively; p=0.004). All patients (n=2) who received medical therapy had a diagnosis of TSC and multiple FCTs and a reduction in tumor size occurred. Tumor size decreased in eight patients spontaneously during follow-up, but increased in one patient who had multiple locations but no TCS. No change in size was observed in the remaining seven cases. None of the fetuses died during the 1-5 year follow-up period. Conclusion: Rhabdomyoma are usually multiple and associated with TSC. Rhabdomyomas with TSC are larger, but most regress spontaneously or respond well to medical treatment after birth, and have an excellent long-term prognosis.
Collapse
Affiliation(s)
- Mustafa Behram
- Clinic of Perinatology, University of Health Sciences Turkey, Kanuni Sultan Süleyman Training and Research Hospital, İstanbul, Turkey
| | - Süleyman Cemil Oğlak
- Clinic of Obstetrics and Gynecology, University of Health Sciences Turkey, Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey
| | - Züat Acar
- Clinic of Perinatology, University of Health Sciences Turkey, Kanuni Sultan Süleyman Training and Research Hospital, İstanbul, Turkey
| | - Salim Sezer
- Clinic of Perinatology, University of Health Sciences Turkey, Kanuni Sultan Süleyman Training and Research Hospital, İstanbul, Turkey
| | - Helen Bornaun
- Clinic of Pediatric Cardiology, University of Health Sciences Turkey, Kanuni Sultan Süleyman Training and Research Hospital, İstanbul, Turkey
| | - Aytül Çorbacıoğlu
- Clinic of Perinatology, University of Health Sciences Turkey, Kanuni Sultan Süleyman Training and Research Hospital, İstanbul, Turkey
| | - İsmail Özdemir
- Clinic of Perinatology, University of Health Sciences Turkey, Kanuni Sultan Süleyman Training and Research Hospital, İstanbul, Turkey
| |
Collapse
|
6
|
Okmen F, Ekici H, Hortu I, Imamoglu M, Ucar B, Ergenoglu AM, Sagol S. Outcomes of antenatally diagnosed fetal cardiac tumors: a 10-year experience at a single tertiary referral center. J Matern Fetal Neonatal Med 2020; 35:3489-3494. [PMID: 32954877 DOI: 10.1080/14767058.2020.1822316] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The purpose of this study was to analyze the clinical and perinatal outcomes along with ultrasonographic characteristics of fetuses with a cardiac tumor. METHODS The data were obtained retrospectively between January 2010 and December 2019 in a tertiary referral center. The Cardiovascular Profile Score (CVPS) was used for the diagnosis of heart failure. Clinical outcomes of the cases identified in the postnatal period were analyzed. RESULTS Fourteen cases were evaluated with the fetal cardiac tumor. One case made the decision to terminate the pregnancy. Perinatal death was seen in 4 (30.7 %) cases out of 13 cases. In 3/14 (21.4%) cases, a solitary cardiac tumor was found while multiple cardiac tumors were found in 11/14 (78.6%) cases. All living cases 9/9 (100%) had the diagnosis of tuberous sclerosis complex (TSC). When the cases which survived were compared with the cases which died during the prenatal period, a significant difference in tumors' biggest diameters (16.44 ± 5.12 mm vs. 32.25 ± 9.28 mm; p: .011, respectively) was found. No statistically significant difference was found in the number of the tumor(s) and heart failure. CONCLUSION Fetal cardiac tumors can have serious perinatal mortality. The cardiac tumor size was found to be associated with perinatal mortality. The survival is not different between the cases with solitary and multiple tumors and those with and without congestive heart failure.
Collapse
Affiliation(s)
- Fırat Okmen
- Department of Obstetrics and Gynecology, Ege University School of Medicine, Izmir, Turkey
| | - Huseyin Ekici
- Department of Obstetrics and Gynecology, Ege University School of Medicine, Izmir, Turkey
| | - Ismet Hortu
- Department of Obstetrics and Gynecology, Ege University School of Medicine, Izmir, Turkey.,Department of Stem Cell, Ege University Institute of Health Sciences, Izmir, Turkey
| | - Metehan Imamoglu
- Department of Obstetrics and Gynecology, Yale School of Medicine, New Haven, CT, USA
| | - Burcu Ucar
- Department of Obstetrics and Gynecology, Ege University School of Medicine, Izmir, Turkey
| | - Ahmet Mete Ergenoglu
- Department of Obstetrics and Gynecology, Ege University School of Medicine, Izmir, Turkey
| | - Sermet Sagol
- Department of Obstetrics and Gynecology, Ege University School of Medicine, Izmir, Turkey
| |
Collapse
|
7
|
Abstract
Fetal intrapericardial teratomas are rare and benign cardiac tumors. By comprehensive literature retrieval of the pertinent articles published since 2000, 49 articles with 61 cases of intrapericadial teratomas were recruited into this study. The intrapericardial teratomas were found during pregnancy in 55 cases (fetal group), while the tumors were detected until neonatal period in 6 cases (neonatal group). In the fetal group, 15 cases were critical with fetal/neonatal respiratory distress or cardiac tamponade. Antenatal treatments including centesis, shunt placement, open fetal surgery and the ex utero intrapartum treatment were required in 24 (43.6%) fetal cases. Postnatal intubation was required in 19 cases with 18 of them having immediate intubation after birth. Postnatal tumor resection was performed in 41 (95.3%) cases. In neonatal group, 4 neonates had respiratory distress and/or cardiac tamponade. Neonatal intubation was required in 1 (16.7%) patient. Surgical tumor resection was performed in all 6 patients. A comparison between the fetal and neonatal groups revealed that the fetal group was associated with higher refractory effusions while the neonatal group had a higher incidence of respiratory distress. Although the all cause death rate was higher in the fetal group than in the neonatal (25.5 vs. 0%), but lack of a statistical significance. Antenatal treatments for fetal intrapericardial teratomas are feasible but carry higher risks in comparison to neonatal cases.
Collapse
Affiliation(s)
- Shi-Min Yuan
- The First Hospital of Putian, Teaching Hospital, Fujian Medical University, Department of Cardiothoracic Surgery, Putian, China
| |
Collapse
|
8
|
Pavlicek J, Klaskova E, Kapralova S, Prochazka M, Vrtel R, Gruszka T, Kacerovsky M. Fetal heart rhabdomyomatosis: a single-center experience. J Matern Fetal Neonatal Med 2019; 34:701-707. [PMID: 31032681 DOI: 10.1080/14767058.2019.1613365] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objectives: The primary aim of the study was to evaluate the prevalence of fetal heart tumors in a single tertiary referral center over a period of 15 years. The secondary aim was to confirm the presence of tuberous sclerosis complex (TSC) through the evaluation of germline mutation in TSC1/TSC2 and assess the outcomes in affected fetuses and newborns.Methods: A retrospective study was conducted between 2003 and 2017. Fetal echocardiography was performed in the second trimester of pregnancy in the study population. The identification of heart tumors and further follow-up were performed by a pediatric cardiologist. Molecular genetic analysis was conducted on fetuses and children in cases where TSC was suspected.Results: In total, 39,018 fetuses were examined between 2003 and 2017. Heart tumors were detected in nine fetuses and were diagnosed as rhabdomyoma in all cases. We identified mutations in one of the TSC1 or TSC2 genes in all cases with multiple rhabdomyomas (8/9). In all born children (5/9), the genetically confirmed diagnosis of TSC was established, and clinically pathological deposits in the brain were found.Conclusion: Fetal heart tumors are usually represented by rhabdomyomas having a good cardiac prognosis. However, rhabdomyoma is usually the first symptom of TSC with a subsequent brain disorder and impaired neurological development.
Collapse
Affiliation(s)
- Jan Pavlicek
- Department of Pediatrics and Prenatal Cardiology, University Hospital Ostrava, Ostrava, Czech Republic.,Biomedical Research Centre, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Eva Klaskova
- Department of Pediatrics, Palacky University Hospital, Palacky University, Olomouc, Czech Republic
| | - Sabina Kapralova
- Department of Pediatrics, Palacky University Hospital, Palacky University, Olomouc, Czech Republic
| | - Martin Prochazka
- Department of Medical Genetics, Palacky University Hospital, Palacky University, Olomouc, Czech Republic
| | - Radek Vrtel
- Department of Medical Genetics, Palacky University Hospital, Palacky University, Olomouc, Czech Republic
| | - Tomas Gruszka
- Department of Pediatrics and Prenatal Cardiology, University Hospital Ostrava, Ostrava, Czech Republic
| | - Marian Kacerovsky
- Biomedical Research Centre, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic.,Department of Obstetrics and Gynecology, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| |
Collapse
|
9
|
Cavalcante CTDMB, Pinto Junior VC, Pompeu RG, Teles ACDO, Bandeira JA, Maia ICL, Tavora FRF, Cavalcante MB, Zamarian ACP, Araujo Júnior E, Castello Branco KM. Perinatal unusual rhabdomyoma location - case report and systematic reviews of the literature. J Matern Fetal Neonatal Med 2019; 34:137-151. [PMID: 30895836 DOI: 10.1080/14767058.2019.1597044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: To report a case of prenatal diagnosis of cardiac rhabdomyoma (CR) and neonatal surgical treatment as well as undertaking a systematic review of the literature to determine most frequent localization of CR, common signs and symptoms, associated pathologies, incidence of surgery, and prognoses for CR.Methods: We conducted systematic review of the literature on CR that were diagnosed and treated in the perinatal period, searching for English language articles in the PubMed/Medline database that were published within the past 20 years, using the following search terms: "cardiac rhabdomyoma"; "neonates"; "newborn"; "surgery".Results: Eighty-two studies were selected, but only 46 studies met the inclusion criteria. After birth, the majority of newborns were asymptomatic; however, murmurs and arrhythmia were also the two most prevalent signs of CR. The most prevalent location was the ventricles, corresponding to 40.3% of all cases, with 53% of these having a rhabdomyoma in the left ventricle. The incidence of multiple tumors was 56%, and in those cases the location of tumors was also most common in the ventricles. Tuberous sclerosis was the most commonly associated pathology, being present in 72% of cases of CR. Surgical treatment occurred in 27% of cases, and 3% of cases required surgery and prostaglandin. Regarding the perinatal outcome, 6% of cases resulted in fetal or neonatal death.Conclusion: CR are benign tumors which tend to spontaneously regress during early childhood but may have unfavorable outcomes in the presence of obstructive lesions and arrhythmias. Surgery is generally necessary in symptomatic patients.
Collapse
Affiliation(s)
| | | | - Ronald Guedes Pompeu
- Pediatric Cardiac Center of the Messejana Hospital Dr. Carlos Alberto Studart Gomes, Fortaleza, Brazil
| | | | - Jeanne Araújo Bandeira
- Pediatric Cardiac Center of the Messejana Hospital Dr. Carlos Alberto Studart Gomes, Fortaleza, Brazil
| | | | | | | | - Ana Cristina Perez Zamarian
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil
| | - Klebia Magalhães Castello Branco
- Pediatric Cardiac Center of the Messejana Hospital Dr. Carlos Alberto Studart Gomes, Fortaleza, Brazil.,Postgraduation Program in Organ Transplantation, State University of Ceará (UECE), Fortaleza, Brazil
| |
Collapse
|
10
|
Masmejan S, Baud D, Ryan G, Van Mieghem T. Management of fetal tumors. Best Pract Res Clin Obstet Gynaecol 2019; 58:107-120. [PMID: 30770283 DOI: 10.1016/j.bpobgyn.2019.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 01/07/2019] [Accepted: 01/08/2019] [Indexed: 12/28/2022]
Abstract
In this review article, we discuss the most common fetal tumors, their prenatal management, and outcomes. Overall, the most important outcome predictors are tumor histology, size, vascularity, and location. Very large lesions, lesions causing cardiac failure, and hydrops and lesions obstructing the fetal airway have the poorest outcome, as they may cause fetal death or complications at the time of delivery. Fetal therapy has been developed to improve outcomes for the most severe cases and can consist of transplacental therapy (sirolimus for rhabdomyomas or steroids for hemangiomas and microcystic lung lesions) or surgical intervention (shunting of cystic masses, tumor ablation, occlusion of blood flow or airway exploration, and protection). Given the rarity of fetal tumors, patients should be referred to expert centers where care can be optimized and individualized to allow the best possible outcomes.
Collapse
Affiliation(s)
- Sophie Masmejan
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Mount Sinai Hospital and University of Toronto, Toronto, Canada; Obstetrics Unit, Mother-Child Department, University Hospital Lausanne, Switzerland
| | - David Baud
- Obstetrics Unit, Mother-Child Department, University Hospital Lausanne, Switzerland
| | - Greg Ryan
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Mount Sinai Hospital and University of Toronto, Toronto, Canada
| | - Tim Van Mieghem
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Mount Sinai Hospital and University of Toronto, Toronto, Canada.
| |
Collapse
|
11
|
Intracardiac Teratoma in an Infant: Report of a New Case and Literature Review. Case Rep Pathol 2018; 2018:6805234. [PMID: 29984028 PMCID: PMC6015667 DOI: 10.1155/2018/6805234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 05/01/2018] [Accepted: 05/12/2018] [Indexed: 11/17/2022] Open
Abstract
Primitive intracardiac tumours are rare, especially in childhood, and are often discovered on autopsy. The intracardiac teratoma is the rarest intracardiac tumours of childhood. Herein, we report the case of an 11-month-old infant, which featured recurrent bronchoalveolitis since the age of 3 months, with a thoracic deformation. Physical examination did found discrete respiratory distress signs. Chest radiography showed large mediastinal enlargement. The computed tomography showed a solid cystic-cloisonned mass with fat and central calcification highly suggestive of an intracardiac teratoma. A radical surgical excision was made and the histological examination found a well circumscribed tumour containing elements of the three germ layers confirming the diagnosis of mature well-differentiated teratoma, with no need of immunohistochemical support.
Collapse
|
12
|
Yuan SM. Fetal cardiac tumors: clinical features, management and prognosis. J Perinat Med 2018; 46:115-121. [PMID: 28343178 DOI: 10.1515/jpm-2016-0311] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 02/21/2017] [Indexed: 11/15/2022]
Abstract
Fetal cardiac tumors are rare and usually benign. While echocardiography is a reliable technique for diagnosing fetal cardiac tumors, their definitive diagnosis relies on pathological examination. The strategies used to manage fetal cardiac tumors are challenging. A good clinical result is their complete regression during pregnancy or shortly after birth, as often occurs with cardiac rhabdomyomas. Moreover, the fetal prognosis depends on the nature of the tumors, namely, their location, size, number and associated complications. The active treatment options for symptomatic fetuses depend on the fetal status and may include fetal open surgery, postnatal tumor resection with or without the bridge of intrauterine pericardiocentesis, and thoracoamniotic shunting. The ex utero intrapartum treatment procedure provides an alternative technique for performing fetal open surgery and has shown promising preliminary results in selected cases, but is invasive for both the mother and fetus.
Collapse
Affiliation(s)
- Shi-Min Yuan
- Department of Cardiothoracic Surgery, The First Hospital of Putian, Teaching Hospital, Fujian Medical University, 389 Longdejing Street, Chengxiang District, Putian 351100, Fujian Province, P.R. China, Tel.: 86 594 6923117
| |
Collapse
|
13
|
Tzani A, Doulamis IP, Mylonas KS, Avgerinos DV, Nasioudis D. Cardiac Tumors in Pediatric Patients: A Systematic Review. World J Pediatr Congenit Heart Surg 2017; 8:624-632. [DOI: 10.1177/2150135117723904] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
This systematic review sought to investigate the current evidence regarding surgical management of primary cardiac tumors in children and adolescents. Twenty-eight studies were deemed eligible, reporting on 745 pediatric patients. Rhabdomyoma was the most prevalent histologic type and echocardiography was the most common diagnostic tool. Cumulative 30-day mortality rate was 6.7%. Rhabdomyomas and teratomas had the highest 30-day mortality. The higher percentage of tumor relapse was noted for myxoma and teratoma. Although cardiac tumors are rare, their atypical clinical presentation, potential for recurrence, and the poor prognosis associated with recurrence elucidate the need for reliable diagnostic and therapeutic management.
Collapse
Affiliation(s)
- Aspasia Tzani
- Surgery Working Group, Society of Junior Doctors, Athens, Greece
| | | | - Konstantinos S. Mylonas
- Surgery Working Group, Society of Junior Doctors, Athens, Greece
- Division of Pediatric Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Dimitrios V. Avgerinos
- Surgery Working Group, Society of Junior Doctors, Athens, Greece
- Department of Cardiothoracic Surgery, New York Presbyterian Medical Center, Weill Cornell College of Medicine, New York, NY, USA
| | - Dimitrios Nasioudis
- Surgery Working Group, Society of Junior Doctors, Athens, Greece
- Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
14
|
Garcia Rodriguez R, Garcia Delgado R, Obreros Zegarra L, Emergui Zhrizen Y, Armas Roca M, Castellano Medina M, Garcia Hernandez JA. Fetal Pericardiocentesis. EUROPEAN MEDICAL JOURNAL 2017. [DOI: 10.33590/emj/10311081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Fetal pericardiocentesis is a safe and effective procedure that is used to drain pericardial effusion in selected fetuses. The aim of the procedure is to reduce the risk of pulmonary hypoplasia, the development of cardiac tamponade and fetal hydrops, and in some cases to allow fetal lung maturity, improving fetal extraction with a better haemodynamic and respiratory condition. In this review, we discuss the indications, technical procedure, and the outcomes of the fetal pericardiocentesis reported in the literature.
Collapse
Affiliation(s)
- Raquel Garcia Rodriguez
- Prenatal Diagnosis and Fetal Medicine Unit, Obstetrics and Gynecology Service, Hospital Universitario Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain
| | - Raquel Garcia Delgado
- Prenatal Diagnosis and Fetal Medicine Unit, Obstetrics and Gynecology Service, Hospital Universitario Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain
| | - Luciana Obreros Zegarra
- Prenatal Diagnosis and Fetal Medicine Unit, Obstetrics and Gynecology Service, Hospital Universitario Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain
| | - Yonit Emergui Zhrizen
- Prenatal Diagnosis and Fetal Medicine Unit, Obstetrics and Gynecology Service, Hospital Universitario Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain
| | - Marta Armas Roca
- Prenatal Diagnosis and Fetal Medicine Unit, Obstetrics and Gynecology Service, Hospital Universitario Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain
| | - Margarita Castellano Medina
- Prenatal Diagnosis and Fetal Medicine Unit, Obstetrics and Gynecology Service, Hospital Universitario Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain
| | - Jose Angel Garcia Hernandez
- Prenatal Diagnosis and Fetal Medicine Unit, Obstetrics and Gynecology Service, Hospital Universitario Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain
| |
Collapse
|
15
|
Yuan SM. Fetal Primary Cardiac Tumors During Perinatal Period. Pediatr Neonatol 2017; 58:205-210. [PMID: 28043830 DOI: 10.1016/j.pedneo.2016.07.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 04/27/2016] [Accepted: 07/15/2016] [Indexed: 11/15/2022] Open
Abstract
Fetal primary cardiac tumors are rare, but they may cause complications, which are sometimes life threatening, including arrhythmias, hydrops fetalis, ventricular outflow/inflow obstruction, cardiac failure, and even sudden death. Among fetal primary cardiac tumors, rhabdomyomas are most common, followed by teratomas, fibromas, hemangiomas, and myxomas. Everolimus, a mammalian target of rapamycin inhibitor, has been reported to be an effective drug to cause tumor remission in three neonates with multiple cardiac rhabdomyomas. Neonatal cardiac surgery for the resection of primary cardiac tumors found by fetal echocardiography has been reported sporadically. However, open fetal surgery for pericardial teratoma resection, which was performed successfully via a fetal median sternotomy in one case report, could be a promising intervention to rescue these patients with large pericardial effusions. These recent achievements undoubtedly encourage further development in early management of fetal cardiac tumors. Owing to the rarity of fetal primary cardiac tumors, relevant information in terms of prenatal diagnosis, treatment, and prognosis remains to be clarified.
Collapse
Affiliation(s)
- Shi-Min Yuan
- Department of Cardiothoracic Surgery, The First Hospital of Putian, Teaching Hospital, Fujian Medical University, Putian 351100, Fujian Province, China.
| |
Collapse
|
16
|
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.
Collapse
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
| |
Collapse
|
17
|
Carrilho MC, Tonni G, Araujo Júnior E. Fetal cardiac tumors: prenatal diagnosis and outcomes. Braz J Cardiovasc Surg 2015; 30:VI-VII. [PMID: 25859881 PMCID: PMC4389519 DOI: 10.5935/1678-9741.20150003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
| | - Gabriele Tonni
- Division of Obstetrics and Gynecology, Guastalla Civil Hospital, Reggio Emilia, Italy,
| | - Edward Araujo Júnior
- Division of Obstetrics, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| |
Collapse
|
18
|
Linnemeier L, Benneyworth BD, Turrentine M, Rodefeld M, Brown J. Pediatric Cardiac Tumors. World J Pediatr Congenit Heart Surg 2015; 6:215-9. [DOI: 10.1177/2150135114563938] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Cardiac tumors in children are rare. Of the cases reported in the literature, nearly all are benign and managed conservatively. Methods: This is a retrospective, observational study of pediatric patients <18 years who presented for surgical evaluation of a cardiac tumor, between 1969 and 2014 at a tertiary care children’s hospital. Presentation, pathology, management, and outcomes were evaluated. Results: Over the last 45 years, 64 patients were evaluated for surgical resection of a cardiac tumor. Rhabdomyoma was the most common neoplasm (58%), and 17% of the tumors had malignant pathologies. While 42% of benign cardiac neoplasms required surgical intervention for significant hemodynamic concerns, 73% of malignant neoplasms underwent radical excision, if possible, followed by adjuvant chemotherapy. Despite a 37% mortality in patients with malignant pathology, an aggressive surgical approach can yield long-term survival in some patients. There were no deaths among patients with benign tumors and 17% had postoperative complications mostly related to mitral regurgitation. Conclusion: Cardiac tumors in children are rare but can be managed aggressively with good outcomes. Benign tumors have an excellent survival with most complications related to tumor location. Malignant tumors have a high mortality rate, but surgery and adjuvant chemotherapy allow for prolonged survival in selected patients.
Collapse
Affiliation(s)
- Laura Linnemeier
- Department of Cardiovascular Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Brian D. Benneyworth
- Department of Cardiovascular Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Mark Turrentine
- Department of Cardiovascular Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Mark Rodefeld
- Department of Cardiovascular Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - John Brown
- Department of Cardiovascular Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| |
Collapse
|
19
|
Li Y, Fang J, Zhou K, Wang C, Hua Y, Shi X, Mu D. Prediction of fetal outcome without intrauterine intervention using a cardiovascular profile score: a systematic review and meta-analysis. J Matern Fetal Neonatal Med 2014; 28:1965-72. [PMID: 25308207 DOI: 10.3109/14767058.2014.974536] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE With the help of fetal echocardiography, cardiovascular profile score (CVPS) can be evaluated. However, no general agreement has been recognized on the prediction value of CVPS on fetal adverse outcome. METHODS Literature review has identified up to Nov 2012 in the databases. Meta-analysis was performed in a fixed/random-effect model using Revman 5.1.1 and Meta-disc 1.4. The differences among different cut-offs were measured by STATA 11.0. RESULTS Result from seven studies reported an outcome in favor of significant lower CVPS in fetus of adverse outcome with std. mean difference of -1.17 (95% CI = -1.78, -0.55). The overall performance of CVPS ≤ 6 prediction adverse outcome evaluated as area under the summary receiver operating characteristic curves (AUC) was 0.8777. The AUC of CVPS ≤ 7 was 0.8728 and the AUC of CVPS ≤ 8 was 0.7207. However, the result indicated the performance of CVPS ≤ 6 prediction adverse outcome had a statistical significance comparing to other two cut-offs. CONCLUSION Analysis has proven the CVPS is a credible index for predicting fetal adverse outcome. And once CVPS decreased at eight, the patient should be observed carefully. With the CVPS dropped at seven, treatment is demanded immediately while some cases suffer irreversible cardiac dysfunction.
Collapse
Affiliation(s)
- Yifei Li
- a Department of Pediatric Cardiovascular Disease , West China Second University Hospital, Sichuan University , Chengdu , Sichuan , China .,b Ministry of Education Key Laboratory of Women and Children's Diseases and Birth Defects , West China Second University Hospital, Sichuan University , Chengdu , Sichuan , China .,d West China Medical School , and
| | - Jie Fang
- e West China Stomatology School, Sichuan University , Chengdu , Sichuan , China
| | - Kaiyu Zhou
- a Department of Pediatric Cardiovascular Disease , West China Second University Hospital, Sichuan University , Chengdu , Sichuan , China .,b Ministry of Education Key Laboratory of Women and Children's Diseases and Birth Defects , West China Second University Hospital, Sichuan University , Chengdu , Sichuan , China .,c Program for Changjiang Scholars and Innovative Research Team in University, West China Second University Hospital, Sichuan University , Chengdu , Sichuan , China
| | - Chuan Wang
- a Department of Pediatric Cardiovascular Disease , West China Second University Hospital, Sichuan University , Chengdu , Sichuan , China .,b Ministry of Education Key Laboratory of Women and Children's Diseases and Birth Defects , West China Second University Hospital, Sichuan University , Chengdu , Sichuan , China .,d West China Medical School , and
| | - Yimin Hua
- a Department of Pediatric Cardiovascular Disease , West China Second University Hospital, Sichuan University , Chengdu , Sichuan , China .,b Ministry of Education Key Laboratory of Women and Children's Diseases and Birth Defects , West China Second University Hospital, Sichuan University , Chengdu , Sichuan , China .,c Program for Changjiang Scholars and Innovative Research Team in University, West China Second University Hospital, Sichuan University , Chengdu , Sichuan , China
| | - Xiaoqing Shi
- a Department of Pediatric Cardiovascular Disease , West China Second University Hospital, Sichuan University , Chengdu , Sichuan , China .,b Ministry of Education Key Laboratory of Women and Children's Diseases and Birth Defects , West China Second University Hospital, Sichuan University , Chengdu , Sichuan , China .,c Program for Changjiang Scholars and Innovative Research Team in University, West China Second University Hospital, Sichuan University , Chengdu , Sichuan , China
| | - Dezhi Mu
- a Department of Pediatric Cardiovascular Disease , West China Second University Hospital, Sichuan University , Chengdu , Sichuan , China .,b Ministry of Education Key Laboratory of Women and Children's Diseases and Birth Defects , West China Second University Hospital, Sichuan University , Chengdu , Sichuan , China .,c Program for Changjiang Scholars and Innovative Research Team in University, West China Second University Hospital, Sichuan University , Chengdu , Sichuan , China
| |
Collapse
|
20
|
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
|
21
|
|
22
|
Yvert M, Vallée L, Maugey-Laulom B. La sclérose tubéreuse de Bourneville : modalités de l’imagerie et complexité du pronostic anténatal. Arch Pediatr 2012. [DOI: 10.1016/s0929-693x(12)71263-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
23
|
Screening for congenital heart defects in the Moravian-Silesian Region: past and present. COR ET VASA 2011. [DOI: 10.33678/cor.2011.174] [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]
|
24
|
Prenatal Diagnosis of Cerebral Tubers by Magnetic Resonance Imaging Following Detection of Cardiac Rhabdomyomas by Prenatal Ultrasound in a Fetus With a Nonsense Mutation in the TSC2 gene. J Med Ultrasound 2011. [DOI: 10.1016/j.jmu.2011.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|