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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.
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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
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Okutucu G, Tanacan A, Sahin D. Clinical outcomes of fetuses with cardiac rhabdomyoma: A case series from a tertiary center. J Obstet Gynaecol Res 2024; 50:342-350. [PMID: 38062975 DOI: 10.1111/jog.15846] [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: 09/30/2023] [Accepted: 11/26/2023] [Indexed: 03/04/2024]
Abstract
AIMS The study aims to evaluate the genetic and clinical outcomes of fetal cardiac rhabdomyoma in our tertiary center. METHODS Data of cases with cardiac rhabdomyoma detected by fetal echocardiography during antenatal follow-up were analyzed retrospectively. RESULTS Nine cases were included in the study. The incidence of cardiac rhabdomyoma was 0.003%. The median fetal diagnosis time was 26th weeks, the most common location was the LV. There was no hemodynamic disorder requiring cardiovascular intervention in any of the cases. Of the eight genetically tested cases, four were tuberous sclerosis complex (TSC) gene-negative, one hereditary TSC2, one de novo TSC1, and two de novo TSC2 gene mutants. Postnatal first-year survival rate of the cases was 88.8%. CONCLUSIONS Cardiac rhabdomyoma is a rare fetal and pediatric pathology that generally is a remarkable finding in the clinical process of TSC. Therefore, cases should be evaluated multisystemically and genetic counseling should be given to the family.
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Affiliation(s)
- Gulcan Okutucu
- Division of Perinatology, Department of Obstetrics and Gynecology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Atakan Tanacan
- Division of Perinatology, Department of Obstetrics and Gynecology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
- Department of Obstetrics and Gynecology, University of Health Sciences, Ankara, Turkey
| | - Dilek Sahin
- Division of Perinatology, Department of Obstetrics and Gynecology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
- Department of Obstetrics and Gynecology, University of Health Sciences, Ankara, Turkey
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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.
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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
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Zhai S, Liu L, Yuan L, Zhao L, Lv Y, Guo J, Yang X. Study on prenatal diagnosis and pregnancy outcome analysis of fetuses with cardiac rhabdomyoma. J Perinatol 2023; 43:864-870. [PMID: 37330616 DOI: 10.1038/s41372-023-01673-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 03/28/2023] [Accepted: 04/04/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVE To investigate the prenatal imaging characteristics, genetic characteristics and pregnancy outcome of fetuses with cardiac rhabdomyoma. STUDY DESIGN The prenatal ultrasound, cranial MRI imaging information and genetic test results of 35 fetuses prenatally diagnosed with cardiac rhabdomyoma were collected and retrospectively analyzed, and the pregnancy outcome was followed up. RESULT Cardiac rhabdomyomas mainly occurred in left ventricular wall and ventricular septum; cranial MRI imaging was found abnormal in 38.1% (8/21) of the fetuses; genetic test was found abnormal in 58.82% (10/17) of the fetuses; the fetus was born in 12 cases and the pregnancy was terminated in 23 cases. CONCLUSION TRIO whole exome sequencing (TrioWES) is recommended as the genetic test regime for cardiac rhabdomyoma. The comprehensive evaluation of prognosis of fetuses needs to consider the genetic results and whether the brain is involved; the prognosis of fetuses with simple cardiac rhabdomyoma is good.
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Affiliation(s)
- Shanshan Zhai
- Prenatal Diagnosis Center, The Third Afffliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ling Liu
- Prenatal Diagnosis Center, The Third Afffliated Hospital of Zhengzhou University, Zhengzhou, China.
| | - Limin Yuan
- Prenatal Diagnosis Center, The Third Afffliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lanlan Zhao
- Prenatal Diagnosis Center, The Third Afffliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuexia Lv
- Prenatal Diagnosis Center, The Third Afffliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jing Guo
- Prenatal Diagnosis Center, The Third Afffliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xuewen Yang
- Prenatal Diagnosis Center, The Third Afffliated Hospital of Zhengzhou University, Zhengzhou, China
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Kesrouani A, Jaber L, Daou L, Mcheik C, Nasr B, Saliba Z. Perinatal outcome in prenatally diagnosed cardiac rhabdomyoma case series. J Neonatal Perinatal Med 2023; 16:563-567. [PMID: 37718863 DOI: 10.3233/npm-221186] [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: 09/19/2023]
Abstract
OBJECTIVE This study aims to determine the characteristics and outcome of prenatally diagnosed cardiac rhabdomyomas. STUDY DESIGN This retrospective descriptive study includes cases referred to our university hospital. We studied sonographic characteristics of rhabdomyoma along with the neonatal outcome. RESULTS Eight cases were included, with a mean gestational age at diagnosis at 31 weeks of gestation and five patients diagnosed after 32 weeks. We noted a male gender in 75%, multiple rhabdomyoma in 50%, mostly situated in the interventricular septum (41%) and valvular regurgitation in 25%. Most patients delivered at term, including five cesareans (62.5%). Six babies survived (75%); three of them were later diagnosed with tuberous sclerosis (50%). CONCLUSION Cardiac rhabdomyoma have variable ultrasound features. The usual favorable outcome can however be complicated by neonatal death (12%), valvular regurgitation and cerebral tuber.
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Affiliation(s)
- A Kesrouani
- Obstetrics and-Gynecology Department, St Joseph University, Beirut, Lebanon
- Prenatal Unit, Bellevue Medical Center, Hotel-Dieu de France University Hospital, Beirut, Lebanon
| | - L Jaber
- Pediatrics Department, St Joseph University, Beirut, Lebanon
| | - L Daou
- Pediatrics Department, St Joseph University, Beirut, Lebanon
| | - C Mcheik
- Obstetrics and-Gynecology Department, St Joseph University, Beirut, Lebanon
- Prenatal Unit, Bellevue Medical Center, Hotel-Dieu de France University Hospital, Beirut, Lebanon
| | - B Nasr
- Prenatal Unit, Bellevue Medical Center, Hotel-Dieu de France University Hospital, Beirut, Lebanon
| | - Z Saliba
- Pediatrics Department, St Joseph University, Beirut, Lebanon
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Tuberous Sclerosis Complex: Genetic counselling and perinatal follow-up. Arch Pediatr 2022; 29:5S3-5S7. [PMID: 36585068 DOI: 10.1016/s0929-693x(22)00283-4] [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: 12/30/2022]
Abstract
Tuberous sclerosis is an autosomal dominant disorder almost fully penetrant with highly variable expression. Most cases are de novo and this diagnosis is sometimes considered during prenatal life in case of cardiac tumor, unique or multiple. The couple should be referred to a specialized tertiary prenatal care center for expertise and information. Fetal molecular testing of the two genes TSC1 and TSC2 is often informative. Prognosis determination for Tuberous Sclerosis remains a difficult task. Cardiac tumors can be sometimes worrying but only a minority will have a pejorative issue and most cases are asymptomatic without any therapeutic intervention needed. Only few cases need surgical or medical treatment. Patients with Tuberous Sclerosis can develop skin, eye, kidney or lung lesions later on, but they are either of limited consequence or treatable. The crux of the matter is the neurological involvement with frequent intellectual deficiency and epilepsy that can be drug-resistant. The absence of lesion on fetal brain MRI is not predictive of any prognosis and does not rule out Tuberous Sclerosis. De novo TSC2 mutation is a negative prognosis factor and conversely, an inherited TSC1 mutation is a more favorable one, but with a severe issue still possible. Facing this cautious prognosis, some couple may opt for termination of pregnancy while others decide to pursue it. It is then fundamental to set cardiac and neurological regular follow-up for these newborns. © 2022 French Society of Pediatrics. Published by Elsevier Masson SAS. All rights reserved.
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Ebrahimi-Fakhari D, Stires G, Hahn E, Krueger D, Franz DN. Prenatal Sirolimus Treatment for Rhabdomyomas in Tuberous Sclerosis. Pediatr Neurol 2021; 125:26-31. [PMID: 34624607 DOI: 10.1016/j.pediatrneurol.2021.09.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 08/10/2021] [Accepted: 09/20/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND In tuberous sclerosis, most cardiac rhabdomyomas regress spontaneously. In some cases, the tumors can cause life-threatening hemodynamic compromise requiring subsequent surgical resection. The mechanistic target of rapamycin inhibitors everolimus and sirolimus have shown to be effective treatments for multiple conditions. There are four reports of off-label treatment with transplacental sirolimus for fetal rhabdomyomas due to tuberous sclerosis complex. The optimal dosing regimen is unknown. METHODS We reviewed the medical records of all patients treated prenatally with sirolimus for rhabdomyomas. All fetuses had a clinical and molecular diagnosis of tuberous sclerosis complex (2012 Consensus Diagnostic Criteria, including a positive genetic test). Clinical history, mechanistic target of rapamycin inhibitor dosing and levels, outcome, and adverse events were reviewed after initiation of sirolimus treatment. RESULTS Three fetuses were treated with maternal sirolimus. Dosing regimens and subsequent trough levels differed from 1 mg/day to 6 mg/day and <1.0 ng/mL to 12.2 ng/mL. Cardiac rhabdomyomas gradually shrank in all patients. Growth restriction was noted in one patient. No severe adverse events occurred during the treatment period. CONCLUSIONS Maternal sirolimus appears to be a safe treatment option in prenatally detected rhabdomyomas with possible need for intervention. Follow-up visits with fetal ultrasound, echocardiography, and laboratory work should be performed weekly during the treatment period. The optimal dosing and trough level timepoints remain unclear. Based on our results, we recommend a sirolimus starting dose of at least 2 mg/m2/day, preferably 3-3.5 mg/m2/day to achieve a target trough level of 10-12 ng/mL.
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Affiliation(s)
- Daniel Ebrahimi-Fakhari
- Division of Neurology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of General Pediatrics, University Children's Hospital Muenster, Muenster, Germany.
| | - Gabrielle Stires
- Division of Neurology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Eunice Hahn
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Darcy Krueger
- Division of Neurology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - David Neal Franz
- Division of Neurology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
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Domnitskaya TM, Sakhno YF, Sedov VP, Savina NM. [Echocardiographic Diagnostics of Heart Tumors]. ACTA ACUST UNITED AC 2021; 61:85-92. [PMID: 34397346 DOI: 10.18087/cardio.2021.7.n1182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 06/22/2020] [Accepted: 03/10/2021] [Indexed: 11/18/2022]
Abstract
The article focuses on ultrasound diagnosis of cardiac tumors (CT). In recent time, the frequency of detecting cardiac neoplasm has been growing. Correct diagnosis at an early stage of the process would allow timely treatment. Before the introduction of two-dimensional echocardiography (EchoCG), life-time diagnosis of CT was very rare. This article describes major echocardiographic criteria for most common benign, malignant, and metastatic CTs. The article is illustrated with original echocardiographic images.
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Affiliation(s)
- T M Domnitskaya
- Medical Institute of the Peoples' Friendship University of Russia, Moscow
| | - Yu F Sakhno
- Medical Institute of the Peoples' Friendship University of Russia, Moscow
| | - V P Sedov
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow
| | - N M Savina
- Central state medical Academy of the President of Russia, Moscow
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Reis LB, Filippi-Chiela EC, Ashton-Prolla P, Visioli F, Rosset C. The paradox of autophagy in Tuberous Sclerosis Complex. Genet Mol Biol 2021; 44:e20200014. [PMID: 33821877 PMCID: PMC8022228 DOI: 10.1590/1678-4685-gmb-2020-0014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 01/17/2021] [Indexed: 12/21/2022] Open
Abstract
Tuberous sclerosis complex (TSC) is an autosomal dominant genetic disorder caused by germline mutations in TSC1 or TSC2 genes, which leads to the hyperactivation of the mTORC1 pathway, an important negative regulator of autophagy. This leads to the development of hamartomas in multiple organs. The variability in symptoms presents a challenge for the development of completely effective treatments for TSC. One option is the treatment with mTORC1 inhibitors, which are targeted to block cell growth and restore autophagy. However, the therapeutic effect of rapamycin seems to be more efficient in the early stages of hamartoma development, an effect that seems to be associated with the paradoxical role of autophagy in tumor establishment. Under normal conditions, autophagy is directly inhibited by mTORC1. In situations of bioenergetics stress, mTORC1 releases the Ulk1 complex and initiates the autophagy process. In this way, autophagy promotes the survival of established tumors by supplying metabolic precursors during nutrient deprivation; paradoxically, excessive autophagy has been associated with cell death in some situations. In spite of its paradoxical role, autophagy is an alternative therapeutic strategy that could be explored in TSC. This review compiles the findings related to autophagy and the new therapeutic strategies targeting this pathway in TSC.
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Affiliation(s)
- Larissa Brussa Reis
- Hospital de Clínicas de Porto Alegre (HCPA), Serviço de Pesquisa Experimental, Laboratório de Medicina Genômica, Porto Alegre, RS, Brazil.,Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Genética e Biologia Molecular, Porto Alegre, RS, Brazil
| | - Eduardo C Filippi-Chiela
- Hospital de Clínicas de Porto Alegre (HCPA), Serviço de Pesquisa Experimental, Laboratório de Medicina Genômica, Porto Alegre, RS, Brazil.,Universidade Federal do Rio Grande do Sul (UFRGS), Instituto de Ciências Básicas da Saúde, Departamento de Ciências Morfológicas, Porto Alegre, RS, Brazil
| | - Patricia Ashton-Prolla
- Hospital de Clínicas de Porto Alegre (HCPA), Serviço de Pesquisa Experimental, Laboratório de Medicina Genômica, Porto Alegre, RS, Brazil.,Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Genética e Biologia Molecular, Porto Alegre, RS, Brazil.,Hospital de Clínicas de Porto Alegre (HCPA), Serviço de Genética Médica, Porto Alegre, RS, Brazil
| | - Fernanda Visioli
- Universidade Federal do Rio Grande do Sul, Faculdade de Odontologia, Departamento de Patologia Oral, Porto Alegre, RS, Brazil
| | - Clévia Rosset
- Hospital de Clínicas de Porto Alegre (HCPA), Serviço de Pesquisa Experimental, Laboratório de Medicina Genômica, Porto Alegre, RS, Brazil.,Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Genética e Biologia Molecular, Porto Alegre, RS, Brazil
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Qi Y, Ding H, Huang Y, Zeng Y, Yu L, Liu L, Zhang Y, Yin A. A Multidisciplinary Approach in Prenatal Diagnosis of TSC With Cardiac Rhabdomyoma as the Initial Symptom. Front Pediatr 2021; 9:628238. [PMID: 34513752 PMCID: PMC8429840 DOI: 10.3389/fped.2021.628238] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 06/21/2021] [Indexed: 11/16/2022] Open
Abstract
The long-term prognosis of a fetus with cardiac rhabdomyoma (CR) depends on the correlation with tuberous sclerosis complex (TSC). In recent years, the numerous variations of uncertain significance (VUS) of TSC genes produced by high-throughput sequencing have made counseling challenging, studies until now have tended to side-step the tricky topics. Here, we integrated detailed parental phenotype, echocardiography, neuro MRI, and genetic information to conduct a comprehensive evaluation of 61 CR fetuses. As a result, multiple CRs and cerebral lesions appeared in 90 and 80%, respectively of fetuses with pathogenic (P)/likely pathogenic (LP) TSC1/TSC2 variations. Overall, 85.7% of the live-born infants with P/LP presented with TSC-associated signs. While, 85.7% of VUS without nervous findings had good prognoses. Genetic evidence and cerebral MRI findings are the most sensitive index to assess long-term prognosis, which complement and confirm each other for a TSC diagnosis. In total, 68.9% of fetuses with CR could benefit from this multidisciplinary approach, which turned out to be potentially clinically actionable with precise clinical/genetic diagnosis or had a foreseeable outcome. Our practice provides a practical and feasible solution for perinatal management and prognostic guidance for fetuses with CR.
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Affiliation(s)
- Yiming Qi
- Prenatal Diagnosis Centre, Guangdong Women and Children Hospital, Guangzhou, China.,Maternal and Children Metabolic-Genetic Key Laboratory, Guangdong Women and Children Hospital, Guangzhou, China
| | - Hongke Ding
- Prenatal Diagnosis Centre, Guangdong Women and Children Hospital, Guangzhou, China.,Maternal and Children Metabolic-Genetic Key Laboratory, Guangdong Women and Children Hospital, Guangzhou, China
| | - Yanlin Huang
- Prenatal Diagnosis Centre, Guangdong Women and Children Hospital, Guangzhou, China.,Maternal and Children Metabolic-Genetic Key Laboratory, Guangdong Women and Children Hospital, Guangzhou, China
| | - Yukun Zeng
- Maternal and Children Metabolic-Genetic Key Laboratory, Guangdong Women and Children Hospital, Guangzhou, China
| | - Lihua Yu
- Maternal and Children Metabolic-Genetic Key Laboratory, Guangdong Women and Children Hospital, Guangzhou, China
| | - Ling Liu
- Maternal and Children Metabolic-Genetic Key Laboratory, Guangdong Women and Children Hospital, Guangzhou, China
| | - Yan Zhang
- Maternal and Children Metabolic-Genetic Key Laboratory, Guangdong Women and Children Hospital, Guangzhou, China
| | - Aihua Yin
- Prenatal Diagnosis Centre, Guangdong Women and Children Hospital, Guangzhou, China.,Maternal and Children Metabolic-Genetic Key Laboratory, Guangdong Women and Children Hospital, Guangzhou, China
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Zhen L, Yang YD, He Y, Pan M, Han J, Yang X, Xu LL, Li DZ. Prenatal genetic diagnosis of cardiac rhabdomyoma: A single-center experience. Eur J Obstet Gynecol Reprod Biol 2020; 249:7-10. [PMID: 32320828 DOI: 10.1016/j.ejogrb.2020.03.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 03/27/2020] [Accepted: 03/30/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The aim of this study is to review our institution's experience with fetal cardiac rhabdomyoma, and to document the prenatal genetic testing for tuberous sclerosis complex (TSC) and clinical outcome of the affected pregnancies. STUDY DESIGN During a four-year period, patients with fetal cardiac rhabdomyoma were detected by echocardiography in the second trimester of pregnancy. Molecular genetic analysis was conducted on fetuses to screen for variants of TSC1/TSC2 genes. We reviewed medical records of these affected pregnancies, including maternal demographics, sonographic findings, genotyping results and pregnancy outcomes. RESULTS Eleven cases with fetal cardiac rhabdomyoma were studied during the study period. A pathogenic variant of TSC1/TSC2 genes was detected in all cases, including two with an inherited variant and nine with a de novo variant. Out of these eleven cases diagnosed prenatally, eight pregnancies were terminated and three continued till term. CONCLUSIONS Cardiac rhabdomyoma is the prenatal sign of TSC. A molecular investigation of TSC1/TSC2 genes should be recommended for fetuses with a rhabdomyoma and the parents, and the prognostic counselling should include TSC and its consequences.
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Affiliation(s)
- Li Zhen
- Prenatal Diagnostic Center, Guangzhou Women and Children's Medical Center Affiliated to Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yan-Dong Yang
- Department of Ultrasound, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yi He
- Prenatal Diagnosis Center, Dongguan Women and Children Healthcare Hospital, Dongguan, Guangdong, China
| | - Min Pan
- Prenatal Diagnostic Center, Guangzhou Women and Children's Medical Center Affiliated to Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Jin Han
- Prenatal Diagnostic Center, Guangzhou Women and Children's Medical Center Affiliated to Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Xin Yang
- Prenatal Diagnostic Center, Guangzhou Women and Children's Medical Center Affiliated to Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Li-Li Xu
- Prenatal Diagnostic Center, Guangzhou Women and Children's Medical Center Affiliated to Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Dong-Zhi Li
- Prenatal Diagnostic Center, Guangzhou Women and Children's Medical Center Affiliated to Guangzhou Medical University, Guangzhou, Guangdong, China.
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