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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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Mallula KK, Sosnowski C, Awad S. Spectrum of Cantrell's pentalogy: case series from a single tertiary care center and review of the literature. Pediatr Cardiol 2013; 34:1703-10. [PMID: 23616208 DOI: 10.1007/s00246-013-0706-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 04/04/2013] [Indexed: 11/27/2022]
Abstract
The pentalogy of Cantrell (PC) was first described in 1958. It includes five anomalies: a deficiency of the anterior diaphragm, a midline supraumbilical abdominal wall defect, a defect in the diaphragmatic pericardium, various congenital intracardiac abnormalities, and a defect of the lower sternum. Five patients showing the PC spectrum are reported. The report presents the prenatal diagnosis, the postnatal course, and the patients' outcome at a tertiary care center from June 2001 to May 2012. A literature review and the management plan for this group of patients also are discussed. All patient data were obtained via electronic medical records retrospectively after approval by the institutional review board at the home institution. The patients in the study were three males and two females. For all of the patients, a prenatal diagnosis had been determined. The mean gestational age at delivery was 36.6 weeks. One patient had associated cranial and spine malformations. All the patients had associated congenital heart disease but a normal karyotype. Four of the five patients died in the first year of life. The ages at death ranged from 0 to 259 days (mean, 46.2 ± 51.8 days). The patients who did not survive had withdrawal of care due to increased morbidity, associated complications, or parental wishes. The pentalogy of Cantrell is a wide spectrum of associations. Patients with the complete PC together with complex congenital heart disease or extracardiac malformations may have a poor prognosis. Incomplete PC cases may have a better outcome based on associated anomalies. Prenatal counseling plays a very important role in the decision-making process for the families and has a significant impact on the postnatal management. A multidisciplinary team approach is essential for successful postpartum outcomes.
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Affiliation(s)
- Kiran K Mallula
- Rush Center for Congenital and Structural Heart Disease, Rush University Medical Center, 1653 W. Congress Parkway, Chicago, IL, 60612, USA
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Perales Puchalt A, Vila-Vives J, Subirá Nadal J, Baamonde Vidarte A, Perales Marín A. Utilidad de la ecografía del primer trimestre en el diagnóstico de la pentalogía de Cantrell: a propósito de un caso. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2013. [DOI: 10.1016/j.gine.2012.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Prenatal diagnosis of treacher-collins syndrome using three-dimensional ultrasonography and differential diagnosis with other acrofacial dysostosis syndromes. Case Rep Obstet Gynecol 2013; 2013:203976. [PMID: 23653874 PMCID: PMC3638565 DOI: 10.1155/2013/203976] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Accepted: 03/18/2013] [Indexed: 12/14/2022] Open
Abstract
Treacher-Collins syndrome (TCS) is a rare dominant autosomal anomaly resulting from malformation or disruption of the development of the first and second branchial arches. It is characterized by micrognathia, malar hypoplasia, and malformations of the eyes and ears. The prenatal diagnosis using two-dimensional ultrasonography (2DUS) is characterized by identification of facial malformations together with polyhydramnios. Three-dimensional ultrasonography (3DUS) has the capacity to spatially display these facial malformations, thus making it easy for the parents to understand them. We present a case of TCS diagnosed in the 33rd week using 3DUS, with postnatal confirmation using cranial computed tomography and anatomopathological analysis.
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Takagi MM, Bussamra LCS, Araujo Júnior E, Drummond CL, Herbst SRS, Nardozza LMM, Moron AF, Aldrighi JM. Prenatal diagnosis of a large epignathus teratoma using two-dimensional and three-dimensional ultrasound: correlation with pathological findings. Cleft Palate Craniofac J 2013; 51:350-3. [PMID: 23398485 DOI: 10.1597/12-222] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Epignathus teratomas are rare tumors that originate in the region of the palate or pharynx and are known as Rathke pouch. They may be associated with other malformations such as a cleft palate and bifid tongue or nose. The prenatal diagnosis can be established by two-dimensional ultrasonography showing a heterogeneous mass protruding through the mouth of the fetus. The three-dimensional ultrasonography in rendering mode permits better understanding of this anomaly by the parents, facilitating the counseling. The importance of prenatal diagnosis lies in the fact that this tumor may obstruct the airways, thus leading to death at birth due to respiratory insufficiency. We report a case of prenatal diagnosis of epignathus teratoma in the 30th week of pregnancy by two-dimensional ultrasonography. We focus on the importance of three-dimensional ultrasonography in rendering mode for demonstrating the spatial relationships of the tumor with the oral cavity and provide correlations between the ultrasound images and the anatomopathological findings.
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Prenatal diagnosis of congenital syphilis using two- and three-dimensional ultrasonography: case report. Case Rep Infect Dis 2012; 2012:478436. [PMID: 22957281 PMCID: PMC3432329 DOI: 10.1155/2012/478436] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Accepted: 07/16/2012] [Indexed: 12/05/2022] Open
Abstract
The numbers of syphilis cases have been increasing considerably, especially in eastern europe, thereby contributing towards greater chances of cases of congenital syphilis. Some of the complications of congenital syphilis can be detected on two-dimensional ultrasonography (2DUS), and these are generally manifested in the second trimester of pregnancy. The commonest ultrasonographic signs are hepatosplenomegaly, placentomegaly, and fetal growth restriction, while lower-frequency occurrences include intrahepatic calcifications, ascites, fetal hydrops, and even fetal death. Three-dimensional ultrasonography (3DUS) is a relatively new imaging technique that is adjuvant to 2DUS and enables detailed assessment of the fetal surface anatomy. We present a case of a 21-year-old primigravida with a diagnosis of congenital syphilis, with obstetric 2DUS findings of hepatosplenomegaly, ascites, pericardial effusion and hyperechogenicity of the cerebral parenchyma. 3DUS in rendering mode allowed clear assessment of the fetal limbs, especially the feet, which appeared twisted and lacked some toes. It allowed the parents to understand the pathological condition better and improved prenatal management and neonatal followup. 3DUS can be used routinely for assessing fetal malformations resulting from congenital infections.
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Riaño CE, Otoya JP, Gentile JI, Mosquera W, Socarrás JA, Castro JM, Cano DJ. Pentalogía de Cantrell (ectopia cordis): reporte de un caso. REVISTA COLOMBIANA DE CARDIOLOGÍA 2010. [DOI: 10.1016/s0120-5633(10)70254-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Pete B, Hajdú J, Harmath A, Csapó Z, Papp C, Szigeti Z, Rigó J. [Pentalogy of Cantrell: six new cases]. Orv Hetil 2009; 150:2068-73. [PMID: 19861294 DOI: 10.1556/oh.2009.28744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
UNLABELLED Cantrell's pentalogy is a rare multiple malformation syndrome consisting of supraumbilical abdominal wall defect, sternal defect, pericardial defect, anterior diaphragmatic defect and heart malformation. AIMS AND METHODS Prenatal ultrasound findings and malformations described during autopsy of the Cantrell's pentalogy cases diagnosed between January 1991 and June 2009 in our institute were reviewed. A literature research was conducted to analyze the prevalence and prenatal detection rate of the five previously described malformations and ectopia cordis in the Cantrell's pentalogy cases. RESULTS Six cases of Cantrell's pentalogy were diagnosed during the study period in our department. Sonography detected multiple malformations in 3 cases, and isolated malformation in 3 cases. Analyzing the data of 49 Cantrell's pentalogy cases altogether showed that, beside abdominal wall defect and ectopia cordis which had the highest prenatal detection rate (83% and 91% with a prevalence of 94% and 69%, respectively), sternal defect and anterior diaphragmatic hernia were also present in a large number of the cases (80% and 73% respectively). CONCLUSION Sonographic identification of the sternal defect or diaphragmatic hernia may help to differentiate Cantrell's pentalogy from malformations part of the syndrome but occurring as isolated defects.
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Affiliation(s)
- Barbara Pete
- Semmelweis Egyetem, Altalános Orvostudományi Kar I. Szülészeti és Nogyógyászati Klinika, Budapest.
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Peixoto-Filho FM, do Cima LC, Nakamura-Pereira M. Prenatal diagnosis of Pentalogy of Cantrell in the first trimester: is 3-dimensional sonography needed? JOURNAL OF CLINICAL ULTRASOUND : JCU 2009; 37:112-114. [PMID: 18506752 DOI: 10.1002/jcu.20498] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
We report the prenatal diagnosis of 2 cases of Pentalogy of Cantrell in the first trimester. In case 1, sonographic evaluation revealed ectopia cordis, omphalocele, and cystic hygroma at 10 weeks' gestation. In case 2, sonographic assessment during the first trimester detected ectopia cordis and omphalocele at 11 weeks' gestation. In both cases, the patient opted for elective pregnancy termination, and Pentalogy of Cantrell was confirmed in 2 male fetuses. We discuss the role of Doppler imaging and 3-dimensional sonography as complementary methods to conventional sonographic assessment of abdominal wall defects at early pregnancy.
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MESH Headings
- Abdominal Wall/abnormalities
- Abdominal Wall/diagnostic imaging
- Abnormalities, Multiple/diagnostic imaging
- Abnormalities, Multiple/surgery
- Abortion, Induced
- Adult
- Ectopia Cordis/diagnostic imaging
- Ectopia Cordis/surgery
- Female
- Hernia, Umbilical/diagnostic imaging
- Hernia, Umbilical/surgery
- Humans
- Imaging, Three-Dimensional
- Lymphangioma, Cystic/diagnostic imaging
- Lymphangioma, Cystic/surgery
- Pregnancy
- Pregnancy Trimester, First
- Sternum/abnormalities
- Sternum/diagnostic imaging
- Syndrome
- Ultrasonography, Doppler
- Ultrasonography, Prenatal/methods
- Young Adult
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Affiliation(s)
- Fernando Maia Peixoto-Filho
- Fetal Medicine Unit, Department of Obstetrics, Fernandes Figueira Institute, Oswaldo Cruz Foundation (IFF-FIOCRUZ), Avenida Rui Barbosa 716, 3 degrees Andar, Flamengo, Rio de Janeiro, Brazil
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van Hoorn JHL, Moonen RMJ, Huysentruyt CJR, van Heurn LWE, Offermans JPM, Mulder ALMT. Pentalogy of Cantrell: two patients and a review to determine prognostic factors for optimal approach. Eur J Pediatr 2008; 167:29-35. [PMID: 17674044 PMCID: PMC2668557 DOI: 10.1007/s00431-007-0578-9] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2007] [Accepted: 07/12/2007] [Indexed: 11/11/2022]
Abstract
Two patients with incomplete pentalogy of Cantrell are described. The first was a girl with a large omphalocele with evisceration of the heart, liver and intestines with an intact sternum. Echocardiography showed profound intracardiac defects. The girl died 33 h after birth. The second patient was a female fetus with ectopia cordis (EC) without intracardiac anomalies; a large omphalocele with evisceration of the heart, stomach, spleen and liver; a hypoplastic sternum and rib cage; and a scoliosis. The pregnancy was terminated. A review of patients described in the literature is presented with the intention of finding prognostic factors for an optimal approach to patients with the pentalogy of Cantrell. In conclusion the prognosis seems to be poorer in patients with the complete form of pentalogy of Cantrell, EC, and patients with associated anomalies. Intracardial defects do not seem to be a prognostic factor.
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Affiliation(s)
- Jeroen H. L. van Hoorn
- Department of Pediatrics, University Hospital Maastricht, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
| | - Rob M. J. Moonen
- Department of Pediatrics, University Hospital Maastricht, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
| | - Clément J. R. Huysentruyt
- Department of Pathology, University Hospital Maastricht, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
| | - L. W. Ernest van Heurn
- Department of Surgery, University Hospital Maastricht, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
| | - Jos P. M. Offermans
- Department of Obstetrics and Gynaecology, University Hospital Maastricht, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
| | - A. L. M. Twan Mulder
- Department of Pediatrics, University Hospital Maastricht, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
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Chen CP. Syndromes and Disorders Associated with Omphalocele (II): OEIS Complex and Pentalogy Of Cantrell. Taiwan J Obstet Gynecol 2007; 46:103-10. [PMID: 17638617 DOI: 10.1016/s1028-4559(07)60003-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Omphalocele-exstrophy-imperforate anus-spinal defects (OEIS) complex is characterized by a combination of omphalocele, exstrophy of the bladder, an imperforate anus, and spinal defects. Pentalogy of Cantrell is characterized by a combination of a midline supraumbilical abdominal wall defect, a defect of the lower sternum, a defect of the diaphragmatic pericardium, a deficiency of the anterior diaphragm, and congenital cardiac anomalies. This article provides a comprehensive review of OEIS complex and pentalogy of Cantrell, including the pathogenesis, prenatal diagnosis, differential diagnosis, and associated malformations. Omphalocele is an important sonographic marker for OEIS complex and pentalogy of Cantrell. Prenatal detection of an abdominal wall defect associated with multiple midline defects should alert one to the possibility of OEIS complex and pentalogy of Cantrell and prompt the genetic investigation and counseling of the disorders.
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MESH Headings
- Abdominal Wall/abnormalities
- Abnormalities, Multiple/diagnosis
- Abnormalities, Multiple/genetics
- Anus, Imperforate/diagnosis
- Anus, Imperforate/genetics
- Bladder Exstrophy/diagnosis
- Bladder Exstrophy/genetics
- Diagnosis, Differential
- Female
- Heart Defects, Congenital/diagnosis
- Heart Defects, Congenital/genetics
- Hernia, Diaphragmatic/diagnosis
- Hernia, Diaphragmatic/genetics
- Hernia, Umbilical/etiology
- Hernias, Diaphragmatic, Congenital
- Humans
- Pregnancy
- Prenatal Diagnosis
- Spinal Dysraphism/diagnosis
- Spinal Dysraphism/genetics
- Sternum/abnormalities
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Affiliation(s)
- Chih-Ping Chen
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan.
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