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Mukai T, Ito A, Shitara Y, Kashima K, Kobayashi M, Shiraga K, Takazawa S, Takahashi N. The importance of designing a protector for a preterm and low birth weight infant with ectopia cordis. Clin Case Rep 2024; 12:e8403. [PMID: 38173890 PMCID: PMC10762480 DOI: 10.1002/ccr3.8403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 12/04/2023] [Accepted: 12/07/2023] [Indexed: 01/05/2024] Open
Abstract
Ectopia cordis is a rare condition with expected low survival rate based on past studies. We encountered a case of a preterm and low birth weight infant with ectopia cordis. When the infant cried, the prolapse of the heart, liver, and intestinal tract worsened. A pressure-applying protector was used to protect the organs and reduce the prolapse. Upon application, the infant's tachypnea and desaturation worsened. Fluoroscopic examination suggested that the pressure from the prolapsed regions was impeding pulmonary expansion and negatively affecting circulation. It is essential to carefully design a protector that accommodates the infant's growth.
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Affiliation(s)
- Takeo Mukai
- Department of PediatricsThe University of Tokyo HospitalTokyoJapan
| | - Atsushi Ito
- Department of PediatricsThe University of Tokyo HospitalTokyoJapan
| | | | - Kohei Kashima
- Department of PediatricsThe University of Tokyo HospitalTokyoJapan
| | - Mika Kobayashi
- Department of Rehabilitation MedicineThe University of Tokyo HospitalTokyoJapan
| | - Kazuhiro Shiraga
- Department of PediatricsThe University of Tokyo HospitalTokyoJapan
| | - Shinya Takazawa
- Department of Pediatric SurgeryThe University of Tokyo HospitalTokyoJapan
| | - Naoto Takahashi
- Department of PediatricsThe University of Tokyo HospitalTokyoJapan
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Araujo Júnior E, Coutinho LG, Bravo-Valenzuela NJ, Aquino P, Rocha LAD, Rizzo G, Tonni G, Respondek-Liberska M, Slodki M, Wolter A, Axt-Fliedner R. Ectopia cordis: prenatal diagnosis, perinatal outcomes, and postnatal follow-up of an international multicenter cohort case series. J Matern Fetal Neonatal Med 2023; 36:2203791. [PMID: 37080921 DOI: 10.1080/14767058.2023.2203791] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
OBJECTIVE This study aimed to analyze prenatal diagnosis, perinatal outcomes, and postnatal follow-up in fetuses with ectopia cordis (EC). METHODS This retrospective analysis accessed 31 patients with EC who were either diagnosed or referred to a tertiary Fetal Medicine centers for EC diagnosis in Brazil, Germany, Italy, and Poland. We analyzed prenatal diagnosis, perinatal outcomes, and follow-up in these patients. RESULTS Our study included a cohort of 31 fetuses with EC, 4 and 27 of whom had partial and complete protrusion of the heart through a ventral defect in the thoracoabdominal wall, respectively. EC was diagnosed by fetal echocardiography at a mean gestational age of 20.3 ± 8.6 weeks (range, 8-35 weeks). Of the four cases, in which the karyotype was performed, all of them had a normal result (1 - 46,XX and 3 - 46,XY). Five patients showed conotruncal abnormalities and six ventricular septal defects. Termination of pregnancy (TOP) was performed in 15 cases (48%) and seven pregnant women had spontaneous fetal demise (22.5%). Of the seven fetuses that were born alive, four of them died, and three infants underwent surgery. Among these three infants, all of them survived, one was 5 months, 13 years old and 29 years old at the time of study completion. CONCLUSIONS Ectopia cordis is associated with high mortality rates and intracardiac/extra-cardiac defects. Ventricular septal defects and conotruncal anomalies were the more common intracardiac defects associated with EC. However, in this cohort of fetuses with EC the incidence of PC was lower than reported in the literature.
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Affiliation(s)
- Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil
- The International Prenatal Cardiology Collaboration Group, Lodz, Poland
| | - Luiza Graça Coutinho
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil
| | - Nathalie Jeanne Bravo-Valenzuela
- Department of Pediatrics, Pediatric Cardiology, School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Postgraduate Program in Health Sciences (Fetal Medicine), Itinerant Continuing Medical Education, Rio de Janeiro, Brazil
| | - Patrícia Aquino
- Postgraduate Program in Health Sciences (Fetal Medicine), Itinerant Continuing Medical Education, Rio de Janeiro, Brazil
| | - Luciane Alves da Rocha
- Postgraduate Program in Health Sciences, Medical School, Federal University of Amazonas (UFAM), Manaus, Brazil
| | - Giuseppe Rizzo
- The International Prenatal Cardiology Collaboration Group, Lodz, Poland
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, Università di Roma Tor Vergata, Rome, Italy
| | - Gabriele Tonni
- Department of Obstetrics and Neonatology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), AUSL di Reggio Emilia, Reggio Emilia, Italy
| | - Maria Respondek-Liberska
- The International Prenatal Cardiology Collaboration Group, Lodz, Poland
- Prenatal Cardiology Department, Research Institute Polish Mother's Memorial Hospital, Lodz, Poland
| | - Maciej Slodki
- The International Prenatal Cardiology Collaboration Group, Lodz, Poland
- Prenatal Cardiology Department, Research Institute Polish Mother's Memorial Hospital, Lodz, Poland
- Faculty of Health Sciences, The Masovian State University, Plock, Poland
| | - Aline Wolter
- Department of Obstetrics and Gynecology, Division of Prenatal Medicine, University-Hospitals Giessen and Marburg Campus, Giessen, Germany
| | - Roland Axt-Fliedner
- The International Prenatal Cardiology Collaboration Group, Lodz, Poland
- Department of Obstetrics and Gynecology, Division of Prenatal Medicine, University-Hospitals Giessen and Marburg Campus, Giessen, Germany
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Başar EZ, Dogan Y, Kayabey Ö, Babaoğlu K. Evaluation of clinical features and outcome of eight fetuses with ectopia cordis; A study from a fetal cardiology center. Congenit Anom (Kyoto) 2023; 63:66-73. [PMID: 36680738 DOI: 10.1111/cga.12508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 01/10/2023] [Accepted: 01/11/2023] [Indexed: 01/22/2023]
Abstract
We aim to evaluate the clinical course and outcome of cases with a prenatal diagnosis of ectopia cordis in our center. In this retrospective study, we analyzed clinical variables including gestational age at diagnosis, maternal age, associated cardiac, extracardiac, genetic anomalies and, outcome in prenatally diagnosed ectopia cordis cases in our tertiary referral center. Eight ectopia cordis cases from seven pregnancies were included in the study. All fetuses had complete type of ectopia cordis and pentalogy of Cantrell. Five multiple pregnancies were found, four were twin pregnancies (three dichorionic diamniotic, one monochorionic monoamniotic) and one was triplet (trichorionic triamniotic). In the monochorionic monoamniotic twin pregnancy, both fetuses have pentalogy of Cantrell. Two cases had intracardiac structural defects including Tetralogy of Fallot and hypoplastic right heart syndrome. Three pregnancies were terminated, four cases delivered alive could not survive beyond the neonatal period. The striking feature in our study is its association with multiple pregnancies.
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Affiliation(s)
- Eviç Zeynep Başar
- Department of Pediatric Cardiology, School of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Yasemin Dogan
- Department of Perinatology, School of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Özlem Kayabey
- Department of Pediatric Cardiology, Mersin City Training and Research Hospital, Mersin, Turkey
| | - Kadir Babaoğlu
- Department of Pediatric Cardiology, School of Medicine, Kocaeli University, Kocaeli, Turkey
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Ugas-Charcape CF, Cerrón Vela C, Melgar Humala E, Herrera Taquia R, Caro Domínguez P. Computed tomography angiography features of children with ectopia cordis. Pediatr Radiol 2022; 53:1019-1026. [PMID: 36585499 DOI: 10.1007/s00247-022-05571-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 11/20/2022] [Accepted: 12/14/2022] [Indexed: 01/01/2023]
Abstract
Ectopia cordis is a rare congenital defect with high mortality, and it remains challenging to radiologists, neonatologists and surgeons. CT angiography provides key information that aids in the decision-making process for possible surgical intervention. This pictorial essay describes CT angiography features in six neonates with ectopia cordis.
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Affiliation(s)
- Carlos F Ugas-Charcape
- Department of Diagnostic Imaging, Instituto Nacional de Salud del Niño San Borja, Av. Javier Prado Este 3101, Lima, 15037, Peru.
| | - Carmen Cerrón Vela
- Department of Diagnostic Imaging, Instituto Nacional de Salud del Niño San Borja, Av. Javier Prado Este 3101, Lima, 15037, Peru
| | - Eneida Melgar Humala
- Department of Cardiovascular Surgery, Instituto Nacional de Salud del Niño San Borja, Lima, Peru
| | - Renée Herrera Taquia
- Service of Tissue Bank, Instituto Nacional de Salud del Niño San Borja, Lima, Peru
| | - Pablo Caro Domínguez
- Unidad de Radiología Pediátrica, Servicio de Radiología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
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Pham TDN, Valente AM, Mayer JE, DeWitt ES, Mah DY. Implanted pacemaker and cardioverter-defibrillator in a patient with ectopia cordis. HeartRhythm Case Rep 2020; 6:110-113. [PMID: 32099802 PMCID: PMC7026567 DOI: 10.1016/j.hrcr.2019.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Tam Dan N Pham
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Anne-Marie Valente
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - John E Mayer
- Department of Cardiovascular Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Elizabeth S DeWitt
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Douglas Y Mah
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
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Smith BJ, Flyer JN, Edwards EM, Soll RF, Horbar JD, Yeager SB. Outcomes for Ectopia Cordis. J Pediatr 2020; 216:67-72. [PMID: 31668886 DOI: 10.1016/j.jpeds.2019.09.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 08/15/2019] [Accepted: 09/10/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To utilize a large multicenter neonatal cohort to describe survival and clinical outcomes of very low birth weight (VLBW) or preterm infants with ectopia cordis. STUDY DESIGN Data were prospectively collected on 2 211 262 infants (born 2000-2017) from 845 US centers. Both VLBW (401-1500 g or 22-29 weeks of gestation) and non-VLBW (>1500 g and >29 weeks) infants had diagnoses or anatomic descriptors consistent with ectopia cordis and/or pentalogy of Cantrell. The primary outcome was neonatal survival, defined as hospital discharge or initial length of stay of ≥12 months. RESULTS In total, 180 infants had ectopia cordis, 135 (76%) with findings of pentalogy of Cantrell. VLBW infants comprised 52% of the population. VLBW mortality was 96% with 79% dying within 12 hours, compared with 59% and 36%, respectively, for non-VLBW. One-third of VLBW infants received life support compared with 65% of non-VLBW. Surgery was reported for 34% of VLBW and 68% of non-VLBW infants. Congenital heart disease was reported in 8% of VLBW and 36% of non-VLBW, with conotruncal abnormalities most common. Survival exceeded 50% for infants >2500 g and >37 weeks of gestation. CONCLUSIONS Survival of VLBW infants with ectopia cordis was poor and substantially worse compared with non-VLBW, with notable discrepancies in resuscitative efforts and surgical interventions. Although gestational age and weight strongly influence current survival, more detailed information regarding the severity of cardiac and noncardiac abnormalities is required to fully determine prognosis and inform counseling.
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Affiliation(s)
| | - Jonathan N Flyer
- Department of Pediatrics, University of Vermont, Burlington, VT; Division of Pediatric Cardiology, University of Vermont, Burlington, VT
| | - Erika M Edwards
- Department of Pediatrics, University of Vermont, Burlington, VT; Department of Mathematics and Statistics, University of Vermont, Burlington, VT; Vermont Oxford Network, Burlington, VT
| | - Roger F Soll
- Department of Pediatrics, University of Vermont, Burlington, VT; Vermont Oxford Network, Burlington, VT; Division of Neonatology, University of Vermont, Burlington, VT
| | - Jeffrey D Horbar
- Department of Pediatrics, University of Vermont, Burlington, VT; Vermont Oxford Network, Burlington, VT; Division of Neonatology, University of Vermont, Burlington, VT
| | - Scott B Yeager
- Department of Pediatrics, University of Vermont, Burlington, VT; Division of Pediatric Cardiology, University of Vermont, Burlington, VT.
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Türkyilmaz G, Avcı S, Sıvrıkoz T, Erturk E, Altunoglu U, Turkyilmazlmaz SE, Kalelioglu IH, Has R, Yuksel A. Prenatal Diagnosis and Management of Ectopia Cordis: Varied Presentation Spectrum. Fetal Pediatr Pathol 2019; 38:127-137. [PMID: 30600745 DOI: 10.1080/15513815.2018.1556367] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Ectopia cordis (EC) is a congenital anomaly associated with heart defects and extracardiac malformations. OBJECTIVES We determined the various presentations of EC diagnosed in our center between 2010 and 2017. RESULTS Seven fetuses from six pregnancies with EC were detected, five during the first trimester. Three were from multiple pregnancies, and both twins had EC in one monochorionic-monoamniotic pregnancy. Abdominal wall defects were detected in six fetuses. Kyphoscoliosis, cephalocele, clubfoot and short umbilical cord were other abnormalities. Five fetuses were terminated, one fetus died in utero, and one baby died on day two of life. Postnatal evaluation performed in all cases additionally detected cleft lips/palates in two fetuses and tetralogy of Fallot in one. CONCLUSION Outcome is poor for these fetuses, EC can occur in a multiple pregnancy, most of the abnormalities can be identified in the first trimester and fetopsy continues to add information to the intrauterine diagnosis.
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Affiliation(s)
- Gürcan Türkyilmaz
- a Department of Obstetrics and Gynecology, Istanbul Faculty of Medicine , Istanbul University , Istanbul , Turkey
| | - Sahin Avcı
- b Department of Medical Genetics , Istanbul Faculty of Medicine, Istanbul University , Istanbul , Turkey
| | - Tugba Sıvrıkoz
- a Department of Obstetrics and Gynecology, Istanbul Faculty of Medicine , Istanbul University , Istanbul , Turkey
| | - Emircan Erturk
- a Department of Obstetrics and Gynecology, Istanbul Faculty of Medicine , Istanbul University , Istanbul , Turkey
| | - Umut Altunoglu
- b Department of Medical Genetics , Istanbul Faculty of Medicine, Istanbul University , Istanbul , Turkey
| | | | - Ibrahim Halil Kalelioglu
- a Department of Obstetrics and Gynecology, Istanbul Faculty of Medicine , Istanbul University , Istanbul , Turkey
| | - Recep Has
- a Department of Obstetrics and Gynecology, Istanbul Faculty of Medicine , Istanbul University , Istanbul , Turkey
| | - Atil Yuksel
- a Department of Obstetrics and Gynecology, Istanbul Faculty of Medicine , Istanbul University , Istanbul , Turkey
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Prenatal 3 RD Trimester Expectation of Fetal or Neonatal Demise and Perinatal Team Approach. PRENATAL CARDIOLOGY 2018. [DOI: 10.1515/pcard-2018-0002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Abstract
INTRODUCTION: The aim of this study was to present our current practice of counseling patients and families with the most severe congenital malformations in the 3rd trimester of pregnancy and to develop practical guidelines for our team and involved healthcare/ socialcare professionals. MATERIAL & METHODS: It was a retrospective evaluation of a series of fetal cases in 2017 from single tertiary center. Maternal obstetrical medical history, time of prenatal detection of the anomaly (1st, 2nd or 3rd trimester), time between last fetal echocardiography and delivery, type of delivery, neonatal birth weight and time of neonatal demise. The total study group was subdived into early demise (during the 1st day after delivery) or late demise > 1st day after delivery. RESULTS: Mean maternal age was 30,4 +/- 5,6 years, and varied between 26 and 38 years. No chronic maternal diseases were found in medical history and no congenital malformations were present in previous children. All women had 1st trimester ultrasound, in 9 cases, it was reported as normal (with NT measurement < 2 mm), in 2 cases extracardiac abnormalities were detected: diaphragmatic hernia and omphalocele ( in both fetal karyotype 46,XY). In nine cases, the abnormalities were detected in midgestation and with maternal wish to continue the pregnancies. There were 8 neonatal deaths within 60 minutes after delivery, including one intrapartum death and 3 “late” neonatal deaths in the intensive care unit (on 12th, 21st and 22nd day). We stress upon the prenatal team approach and counseling of future parents, in order to prepare them for poor neonatal outcome. CONCLUSIONS: 1. In the most severe cases when fetal or neonatal demise was suspected, the two different opinions of specialists might not be enough and a third opinion should be recommended before final decision. 2. A Fetal Team of specialists is necessary in cases of expected fetal/neonatal demise in order to prepare a written report of recommended perinatal management for all sides involved in this difficult problem.
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Abstract
Shamberger and Welch classify sternal malformations into four types: thoracic ectopia cordis, cervical ectopia cordis, thoraco-abdominal ectopia cordis, and cleft sternum. Cleft sternum is the most common subset, with a reported incidence of 1 in 50,000 to 100,000 live births, representing 0.15% of all anterior chest wall malformations. Acostello et al further classify cleft sternum into complete or partial (superior, medium, inferior) with a simple superior partial cleft sternum being by far the most common with an orthotopic heart, intact pericardium, and normal skin coverage. Associated anomalies with superior partial cleft sternum are rare, but can include cervicofacial hemangiomas, midline raphe from the tip of the cleft to the umbilicus, and PHACES (posterior fossa malformations, facial hemangiomas, arterial anomalies with coarctation of aorta, cardiac defects, eye abnormalities, sternal cleft, and supraumbilical raphe) syndrome. The more rare inferior partial clefts are associated with thoraco-abdominal ectopia cordis as part of the Pentalogy of Cantrell (omphalocele, anterior diaphragmatic hernia, sternal cleft, ectopia cordis, ventricular septal defect/left ventricular diverticulum). This review summarizes the current knowledge of all four types of sternal malformations, and provides guidance for optimal anesthetic and perioperative care of these children.
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Affiliation(s)
- John H Nichols
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Viviane G Nasr
- Division of Cardiac Anesthesia, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
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