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Ng LY, McGuinness J, Prendiville T, Franklin O, Walsh M, Kenny D, Nolke L, McMahon CJ. Cardiac Rhabdomyomas Presenting with Critical Cardiac Obstruction in Neonates and Infants: Treatment Strategies and Outcome, A Single-Center Experience. Pediatr Cardiol 2024; 45:1132-1141. [PMID: 38480570 PMCID: PMC11056332 DOI: 10.1007/s00246-024-03420-0] [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: 11/28/2023] [Accepted: 01/16/2024] [Indexed: 04/29/2024]
Abstract
Cardiac rhabdomyomas are the most common benign pediatric heart tumor in infancy, which are commonly associated with tuberous sclerosis complex (TSC). Most rhabdomyomas are asymptomatic and spontaneously regress over time. However, some cases especially in neonates or small infants can present with hemodynamic instability. Surgical resection of the tumor, which has been the gold standard in alleviating obstruction, is not always possible and may be associated with significant morbidity and mortality. Recently, mammalian target of rapamycin inhibitors (mTORi) have been shown to be safe and effective in the treatment of TSC. We present the outcomes of neonates and an infant who received treatment for symptomatic rhabdomyomas at a tertiary cardiology center. Medical records were reviewed to obtain clinical, demographic, and outcome data. Six patients received interventions for symptomatic rhabdomyomas, median age at presentation was 1 day old (range from 1 to 121 days old), and 67% of the patients had a pathogenic mutation in TSC gene. One patient underwent surgical resection of solitary tumor at right ventricular outflow tract (RVOT) successfully. In the four patients with left ventricular outflow tract (LVOT) obstruction, two patients received combined therapy of surgical debulking of LVOT tumor, Stage I palliation procedure, and mTORi and two patients received mTORi therapy. One patient with RVOT obstruction underwent ductal stenting and received synergistic mTORi. Four of the five patients had good response to mTORi demonstrated by the rapid regression of rhabdomyoma size. 83% of patients are still alive at their latest follow-up, at two to eight years of age. One patient died on day 17 post-LVOT tumor resection and Hybrid stage one due to failure of hemostasis, in the background of familial factor VII deficiency. Treatment of symptomatic rhabdomyoma requires individualized treatment strategy based on the underlying pathophysiology, with involvement of multidisciplinary teams. mTORi is effective and safe in inducing rapid regression of rhabdomyomas. A standardized mTORi prescription and monitoring guide will ensure medication safety in neonates and infants with symptomatic cardiac rhabdomyoma. Although the majority of tumors responded to mTORi, some prove to be resistant. Further studies are warranted, ideally involving multiple international centers with a larger number of patients.
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Affiliation(s)
- Li Yen Ng
- Department of Paediatric Cardiology, Children's Health Ireland at Crumlin, Dublin, 12, Ireland
| | - Jonathan McGuinness
- Department Paediatric Cardiology, Department of Congenital Cardiothoracic Surgery, Children's Health Ireland, Crumlin, Dublin, 12, Ireland
| | - Terence Prendiville
- Department of Paediatric Cardiology, Children's Health Ireland at Crumlin, Dublin, 12, Ireland
| | - Orla Franklin
- Department of Paediatric Cardiology, Children's Health Ireland at Crumlin, Dublin, 12, Ireland
| | - Mark Walsh
- Department of Paediatric Cardiology, Children's Health Ireland at Crumlin, Dublin, 12, Ireland
| | - Damien Kenny
- Department of Paediatric Cardiology, Children's Health Ireland at Crumlin, Dublin, 12, Ireland
| | - Lars Nolke
- Department Paediatric Cardiology, Department of Congenital Cardiothoracic Surgery, Children's Health Ireland, Crumlin, Dublin, 12, Ireland
| | - Colin J McMahon
- Department of Paediatric Cardiology, Children's Health Ireland at Crumlin, Dublin, 12, Ireland.
- UCD School of Medicine, Belfield, Dublin, 4, Ireland.
- Maastricht School of Health Professions Education, Maastricht, The Netherlands.
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2
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Saleem SA, Mustafa FEZA, Abd-Elhafeez HH, Ahmed GA. Congenital and gynecological tumors: A review. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024:108316. [PMID: 38653587 DOI: 10.1016/j.ejso.2024.108316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 02/23/2024] [Accepted: 03/30/2024] [Indexed: 04/25/2024]
Abstract
Congenital tumors are rare, and malignant congenital tumors are uncommon. Benign tu,mors might be life-threatening, depending on the location and size of the tumor. Different factors affect congenital tumors, such as maternal and placental hormones and environmental factors such as drugs, radiation, and infection. Developing fetal imaging methods and continuous follow-up during pregnancy are important factors in congenital tumor prognosis. Ultrasound is the most common method used for fetal evaluation. The complementary evaluation method is MRI. Both methods are helpful and widely spread for the detection of congenital tumors. These imaging methods help the medical team make a suitable decision about therapy. Some of these tumors regressed spontaneously, and some need surgical treatments. Treatment of tumors has developed rapidly, and recently molecular-targeted drugs have been used.
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Affiliation(s)
- Shady A Saleem
- President of the Arab Society of Fetal Medicine & Surgery, Cairo, Egypt.
| | | | - Hanan H Abd-Elhafeez
- Department of Cell and Tissues, Faculty of Vet. Medicine, Assiut University, 71526, Egypt.
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3
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Sundari A, Gurusamy U. Cardiac fibroma presenting as hypoplastic left heart syndrome in a foetus: causal or coincidental? BMJ Case Rep 2024; 17:e258742. [PMID: 38514154 PMCID: PMC10961559 DOI: 10.1136/bcr-2023-258742] [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] [Indexed: 03/23/2024] Open
Abstract
Primary cardiac tumours are very rare. Cardiac tumours in the perinatal period are even more uncommon with a prevalence of 0.0017% to 0.28% in autopsy series. The majority of benign cardiac tumours are cardiac rhabdomyomas, followed by cardiac fibromas. Another rare congenital heart disease is hypoplastic left heart syndrome (HLHS). Here we present a 21-week-old foetus diagnosed antenatally with HLHS on foetal echocardiogram. An autopsy done on the foetus following medical termination of pregnancy revealed a cardiac fibroma in the ventricular septum. It is very uncommon to have a combination of two congenital heart diseases. An extensive literature review revealed only three cases that had rhabdomyoma and associated HLHS. This case presented with cardiac fibroma which in early gestation would have resulted in left ventricular outflow obstruction leading to the development of HLHS. Small cardiac tumours which are difficult to detect by echocardiogram in early gestation can lead to the development of HLHS. A thorough and hierarchical autopsy examination of such cases can help in a better understanding of the relationship between HLHS and cardiac tumours.
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Affiliation(s)
- Abinaya Sundari
- Pathology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Umamaheshwari Gurusamy
- Pathology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
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Fesslova VME, Evangelista M, Piazza L, Saracino A, Andronache A, Chiarello C, Varrica A, Giamberti A, Frigiola A. Regression of Cardiac Rhabdomyomas Producing a Severe Aortic Stenosis: Case Report and Discussion of the Literature. Diagnostics (Basel) 2024; 14:470. [PMID: 38472942 DOI: 10.3390/diagnostics14050470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/23/2024] [Accepted: 02/16/2024] [Indexed: 03/14/2024] Open
Abstract
We describe a case of a voluminous rhabdomyoma (R) detected by fetal echocardiography at 32 weeks' gestation (w.g.) obstructing the left ventricular inflow and aortic outflow tract, with a moderate aortic gradient at birth, not needing immediate surgery. At follow-up, the mass progressively regressed, leaving the aortic valve partly damaged, with a gradient that increased to a maximum of 100 mmHg at 9 years. The girl was then operated on successfully by a plasty of the aortic valve. The literature regarding R is discussed.
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Affiliation(s)
- Vlasta M E Fesslova
- Center of Fetal Cardiology, IRCCS Policlinico San Donato, San Donato, 20097 Milan, Italy
| | - Martina Evangelista
- Department of Pediatric and Adult Congenital Cardiology, IRCCS Policlinico San Donato, San Donato, 20097 Milan, Italy
| | - Luciane Piazza
- Department of Pediatric and Adult Congenital Cardiology, IRCCS Policlinico San Donato, San Donato, 20097 Milan, Italy
| | - Antonio Saracino
- Department of Pediatric and Adult Congenital Cardiology, IRCCS Policlinico San Donato, San Donato, 20097 Milan, Italy
| | - Andreea Andronache
- Department of Pediatric and Adult Congenital Cardiology, IRCCS Policlinico San Donato, San Donato, 20097 Milan, Italy
| | - Carmelina Chiarello
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, San Donato, 20097 Milan, Italy
| | - Alessandro Varrica
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, San Donato, 20097 Milan, Italy
| | - Alessandro Giamberti
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, San Donato, 20097 Milan, Italy
| | - Alessandro Frigiola
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, San Donato, 20097 Milan, Italy
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Weigel N, Hintz S, Kaplinski M, Barth R, Balakrishnan K, Panelli D, Ma M, Chitkara R. Prenatal Diagnosis and Postnatal Management of a Fetal Pericardial Mass. Neoreviews 2023; 24:e683-e689. [PMID: 37777619 DOI: 10.1542/neo.24-10-e683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/02/2023]
Affiliation(s)
- Nicole Weigel
- Fetal and Pregnancy Health Program, Lucile Packard Children's Hospital, Stanford Medicine Children's Health, Palo Alto, CA
| | - Susan Hintz
- Fetal and Pregnancy Health Program, Lucile Packard Children's Hospital, Stanford Medicine Children's Health, Palo Alto, CA
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA
| | - Michelle Kaplinski
- Division of Cardiology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA
| | - Richard Barth
- Fetal and Pregnancy Health Program, Lucile Packard Children's Hospital, Stanford Medicine Children's Health, Palo Alto, CA
- Department of Radiology/Pediatric Radiology, Stanford University School of Medicine, Palo Alto, CA
| | - Karthik Balakrishnan
- Division of Pediatrics, Department of Otolaryngology (Head and Neck Surgery), Stanford University School of Medicine, Palo Alto, CA
| | - Danielle Panelli
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Palo Alto, CA
| | - Michael Ma
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Palo Alto, CA
| | - Ritu Chitkara
- Fetal and Pregnancy Health Program, Lucile Packard Children's Hospital, Stanford Medicine Children's Health, Palo Alto, CA
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA
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Inserra MC, Cannizzaro MT, Passaniti G, Celona A, Secinaro A, Curione D, D'Angelo T, Garretto O, Romeo P. MR imaging of primary benign cardiac tumors in the pediatric population. Heliyon 2023; 9:e19932. [PMID: 37809686 PMCID: PMC10559362 DOI: 10.1016/j.heliyon.2023.e19932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 07/25/2023] [Accepted: 09/06/2023] [Indexed: 10/10/2023] Open
Abstract
Primary cardiac tumors are rare in all ages, especially in children, with a reported prevalence range of 0.0017-0.28% in autopsy series. Due to their rarity, the diagnostic and therapeutic pathways reserved to them are usually described by single case reports, leading to the point where a common diagnostic protocol is imperative to obtain a differential diagnosis. The first diagnostic approach is done with transthoracic echocardiogram (TTE), due to its wide availability, low cost, absence of ionizing radiations and non-invasiveness. Several tumors are discovered incidentally and, in many cases, TTE is helpful to determine location, size and anatomical features, playing a key role in the differential diagnosis. In the last few years, cardiac magnetic resonance imaging (CMR) has had an increased role in the diagnostic pathway of pediatric cardiac masses, due to its high accuracy in characterizing mass tissue properties (especially for soft tissue), and in detecting tumor size, extent, pericardial/pleural effusion, leading to the correct diagnosis, treatment and follow-up. Therefore, nowadays, several consensus statements consider CMR as a leading imaging technique, thanks to its non-invasive tissue characterization, without the use of ionizing radiation, in an unrestricted field of view. As suggested by the most recent literature, the pediatric protocol is not so different from the adult one, adapted to the size and cardiac frequency of the patient, sometimes requiring special conditions such as free-breathing sequences and/or sedation or general anesthesia in non-cooperating patients.
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Affiliation(s)
| | | | - Giulia Passaniti
- Division of Cardiology, A.O.U. Policlinico “G. Rodolico - San Marco”, Catania, Italy
| | - Antonio Celona
- UOC Radiodiagnostica, San Vincenzo Hospital, Provincial Health Agency of Messina, Taormina, Italy
| | - Aurelio Secinaro
- Advanced Cardiothoracic Imaging, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Davide Curione
- Advanced Cardiothoracic Imaging, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Tommaso D'Angelo
- Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital “Policlinico G. Martino”, Messina Italy
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - Orazio Garretto
- UOSD Radiologia 2 CAST, A.O.U. Policlinico “G. Rodolico - San Marco”, Catania, Italy
| | - Placido Romeo
- Radiology Department of AO “San Marco”, A.O.U. Policlinico “G. Rodolico - San Marco”, Catania, Italy
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Sardar S, Dey R, Mukherjee S, Pal S. Diagnostic dilemma in a case of neonatal cardiac tumor - The importance of histopathology and mutation analysis in clinical practice. Ann Pediatr Cardiol 2023; 16:56-60. [PMID: 37287838 PMCID: PMC10243658 DOI: 10.4103/apc.apc_79_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 07/28/2022] [Accepted: 08/17/2022] [Indexed: 06/09/2023] Open
Abstract
Fetal or neonatal cardiac tumors are rarely encountered in neonatal practice. Moreover, these can be the earliest manifestation of underlying systemic conditions, such as tuberous sclerosis. Cardiac tumors are primarily diagnosed by characteristic findings in transthoracic echocardiography. However, these findings are not absolute, and histopathology remains the gold standard in diagnosing cardiac tumors. Sometimes, doubtful imaging findings can delay the diagnosis and initiation of definitive management. We describe a case of fetal and neonatal cardiac tumor where histopathology served as a benchmark in making a diagnosis and helped in identifying the underlying systemic disease.
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Affiliation(s)
- Syamal Sardar
- Department of Neonatology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Rakesh Dey
- Department of Neonatology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Suchandra Mukherjee
- Department of Neonatology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Somnath Pal
- Department of Neonatology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
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8
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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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9
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Grgat D, Dilber D, Hrabak Paar M. Common benign primary pediatric cardiac tumors: a primer for radiologists. Jpn J Radiol 2022; 41:477-487. [PMID: 36495370 DOI: 10.1007/s11604-022-01371-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 11/29/2022] [Indexed: 12/14/2022]
Abstract
Cardiac tumors are neoplasms arising from or located in the heart or the pericardium. Although rare, primary cardiac tumors in children require an accurate and timely diagnosis. Most pediatric primary cardiac tumors are benign (around 90%). Echocardiography is the first imaging modality used due to its availability, noninvasiveness, inexpensiveness, and absence of ionizing radiation. Computed tomography (CT) and magnetic resonance imaging (MRI) offer better soft tissue visualization as well as better visualization of extracardiac structures. A great advantage of MRI is the possibility of measuring cardiac function and blood flow, which can be important for obstructing cardiac tumors. In this article, we will offer a brief review of clinical, echocardiographic, CT, and MRI features of cardiac rhabdomyomas, fibromas, teratomas, and lipomas providing their differential diagnosis.
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Affiliation(s)
- Dora Grgat
- Institute for Emergency Medicine of Zagreb County, Velika Gorica, Croatia
| | - Daniel Dilber
- School of Medicine, Department of Pediatrics, University of Zagreb, University Hospital Center Zagreb, Zagreb, Croatia
| | - Maja Hrabak Paar
- School of Medicine, Department of Diagnostic and Interventional Radiology, University of Zagreb, University Hospital Center Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia.
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Sakamoto Y, Okada S, Maekawa R, Muneuchi J, Sugitani Y, Ochiai Y, Kamimura T, Joo K, Onishi Y, Kobayashi M, Kawakami T, Motoshita J, Hasegawa S. Fetal cardiac capillary hemangioma resulting in tachyarrhythmia. Echocardiography 2022; 39:1457-1461. [PMID: 36258638 DOI: 10.1111/echo.15468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/17/2022] [Accepted: 09/19/2022] [Indexed: 11/30/2022] Open
Abstract
We present the case of a fetus with cardiac capillary hemangioma in the right atrial cavity. The tumor showed dramatic growth between the 28th and 32nd week of gestation and resulted in tachyarrhythmia. The patient was born at the 33 weeks of gestation weighing 2430 g via urgent cesarean section because the rapidly growing cardiac tumor caused incessant tachyarrhythmia, pericardial effusion, and fetal circulatory incompetence. Coronary angiography revealed that the right coronary artery drained into the tumor. Due to hemodynamic deterioration, the patient underwent subtotal resection of the tumor on the 2nd day after birth. Histopathological examination revealed an undifferentiated capillary hemangioma. The patient was discharged at the age of 86 days, as the tachyarrhythmia and hemodynamic incompetence had subsided; however, bradycardia and intermittent atrioventricular conduction disturbance gradually developed. Capillary hemangioma, a rare primary cardiac space-occupying tumor in children, can invade the conduction system.
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Affiliation(s)
- Yukifumi Sakamoto
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Seigo Okada
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Ryo Maekawa
- Department of Obstetrics and Gynecology, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Jun Muneuchi
- Department of Pediatrics, Japan Community Healthcare Organization Kyusyu Hospital, Kitakyusyu, Fukuoka, Japan
| | - Yuichiro Sugitani
- Department of Pediatrics, Japan Community Healthcare Organization Kyusyu Hospital, Kitakyusyu, Fukuoka, Japan
| | - Yoshie Ochiai
- Department of Cardiovascular Surgery, Japan Community Healthcare Organization Kyusyu Hospital, Kitakyusyu, Fukuoka, Japan
| | - Tetsuro Kamimura
- Department of Pediatric Surgery, Japan Community Healthcare Organization Kyusyu Hospital, Kitakyusyu, Fukuoka, Japan
| | - Kunihiko Joo
- Department of Cardiovascular Surgery, Japan Community Healthcare Organization Kyusyu Hospital, Kitakyusyu, Fukuoka, Japan
| | - Yuji Onishi
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Masaru Kobayashi
- Department of Pediatrics, Japan Community Healthcare Organization Kyusyu Hospital, Kitakyusyu, Fukuoka, Japan
| | - Takeshi Kawakami
- Department of Obstetrics and Gynecology, Japan Community Healthcare Organization Kyusyu Hospital, Kitakyusyu, Fukuoka, Japan
| | - Junichi Motoshita
- Department of Pathology, Japan Community Healthcare Organization Kyusyu Hospital, Kitakyusyu, Fukuoka, Japan
| | - Shunji Hasegawa
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
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D’Anna C, Villani A, Ammirati A, Francalanci P, Ragni L, Cecconi G, Secinaro A, Chinali M, Santilli A, Guccione P, Galletti L, Brancaccio G. New Onset Cardiac Murmur and Exertional Dyspnea in an Apparently Healthy Child: A Rare Localization of Obstructive Myxoma in the Right Ventricle Outflow Tract without Pulmonary Embolization-A Case Report and Literature Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12888. [PMID: 36232202 PMCID: PMC9566503 DOI: 10.3390/ijerph191912888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/26/2022] [Accepted: 10/05/2022] [Indexed: 06/16/2023]
Abstract
Myxomas are slowly growing benign neoplasms which are rare in children. Up to 80% can be located in the left atrium and generate symptoms such as embolism, cardiac failure, fever and weight loss. Rarely, myxomas can be detected in the right ventricle outflow tract, causing arrhythmias, pulmonary emboli and sudden death. We report the case of a 13-year-old healthy child brought to the Emergency Department (ED) of the Children's Hospital Bambino Gesù, Rome, for recent dyspnea, chest pain on exertion and new onset cardiac murmur. Patient underwent medical examination and echocardiogram with the finding of a rounded and lobulated voluminous mass in the right ventricle outflow tract (RVOT) which caused severe obstruction. The contrast computed tomography (CT) scan confirmed the presence of a heterogeneously enhancing soft-tissue mass occupying the RVOT with no evidence of pulmonary embolization. The mass was surgically excised, and the pathologic examination confirmed our suspicion of myxoma. Our experience suggests that myxoma can have mild clinical symptoms, the presentation may be non-specific, and diagnosis can be a challenge Careful examination and a diagnostic imaging workup, primarily with the transthoracic echocardiogram, are needful to make a rapid differential diagnosis and to better manage surgical treatment and follow-up.
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Affiliation(s)
- Carolina D’Anna
- Department of Cardiac Surgery, Cardiology and Heart and Lung Transplant, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Alberto Villani
- Department of Emergency, Admission and General Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Antonio Ammirati
- Department of Emergency, Admission and General Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Paola Francalanci
- Department of Pathological Anatomy, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Laura Ragni
- Department of Cardiac Surgery, Cardiology and Heart and Lung Transplant, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Giulia Cecconi
- Department of Cardiac Surgery, Cardiology and Heart and Lung Transplant, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Aurelio Secinaro
- Advanced Cardiovascular Imaging Unit, Department of Imaging, IRCCS Bambino Gesù Children’s Hospital, 00165 Rome, Italy
| | - Marcello Chinali
- Department of Cardiac Surgery, Cardiology and Heart and Lung Transplant, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Antonella Santilli
- Department of Cardiac Surgery, Cardiology and Heart and Lung Transplant, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Paolo Guccione
- Department of Cardiac Surgery, Cardiology and Heart and Lung Transplant, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Lorenzo Galletti
- Department of Cardiac Surgery, Cardiology and Heart and Lung Transplant, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Gianluca Brancaccio
- Department of Cardiac Surgery, Cardiology and Heart and Lung Transplant, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
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Vakrilova L, Marinov R, Hitrova-Nikolova S, Dobrev D, Denev M, Lazarov S. Cardiac Myosarcoma in a Newborn Infant-A Case Report and Literature Review. Front Cardiovasc Med 2021; 8:675202. [PMID: 34336944 PMCID: PMC8316586 DOI: 10.3389/fcvm.2021.675202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 06/21/2021] [Indexed: 11/28/2022] Open
Abstract
Background: Malignant cardiac neoplasms are extremely rare in neonates. Prenatal diagnosis is often not available. Initial symptoms can mimic non-cardiac diseases. We present a pre-mature newborn, birth-weight 2,480 g, 34 gestational weeks, which underwent cardiac surgery due to a cardiac tumor. Case Summary: This was a 3–rd pregnancy after two spontaneous abortions to a mother with thrombophilia, diabetes, hydramnios, and retroplacental hematoma. The baby was admitted to NICU with transitory respiratory failure and inborn infection; hence oxygen-supplementation and antibiotics were initiated. On day 11 a deterioration with tachypnea, high oxygen requirements, significantly increasing C-reactive protein values were noted. Chest radiographs were unremarkable. On day 18 a life-threatening condition with clinical symptoms of shock was identified. Echocardiography showed a large tumor formation in the right atrium, reduced blood flow in the right ventricle and pulmonary artery. On day 19 cardiac surgery was performed: a large tumor with a myxomatous appearance that occupied the cavity of the right atrium and infiltrated the annulus of the tricuspid valve was extirpated. The front wall was restored with a patch. Hemodynamics was temporarily stabilized. On the following day, ventricular fibrillation and asystole occurred. Despite life support efforts, the outcome was lethal. The histological result confirmed leiomyosarcoma of the right atrium and right ventricular hypotrophy. Conclusion: Inborn cardiac sarcomas are extremely rare. The prognosis is poor. Due to fast progression in the third trimester, they can be missed by fetal echocardiography in earlier pregnancy. The postnatal clinical course is aggressive, not specific until invasive infiltration or obstruction by the tumor mass occurred. In our case, the sarcoma mimicked an inborn infection, followed by nosocomial infection and septic shock. Despite low incidence, cardiac tumors should be kept in mind and echocardiography should be conducted if there are unclear symptoms with progressive deterioration during the neonatal period.
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Affiliation(s)
- Liliya Vakrilova
- Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria.,Department of Neonatology, University Obstetrics and Gynecology Hospital "Maichin Dom", Sofia, Bulgaria
| | - Rumen Marinov
- Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria.,Department of Pediatric Cardiology, National Cardiac Hospital, Sofia, Bulgaria
| | - Stanislava Hitrova-Nikolova
- Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria.,Department of Neonatology, University Obstetrics and Gynecology Hospital "Maichin Dom", Sofia, Bulgaria
| | - Dobri Dobrev
- Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria.,Department of Pediatric Cardiology, National Cardiac Hospital, Sofia, Bulgaria
| | - Maxim Denev
- Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria.,Department of Pediatric Cardiology, National Cardiac Hospital, Sofia, Bulgaria
| | - Stoyan Lazarov
- Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria.,Department of Pediatric Cardiology, National Cardiac Hospital, Sofia, Bulgaria
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13
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Yamamoto K, Maki Y, Sato Y, Tanaka H, Fukushima T, Ushijima J, Furukawa S, Sameshima H, Kataoka H. Multiple cardiac rhabdomyomas not associated with tuberous sclerosis in a dizygotic twins: a case report. J Med Case Rep 2021; 15:334. [PMID: 34218815 PMCID: PMC8256619 DOI: 10.1186/s13256-021-02943-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 06/04/2021] [Indexed: 11/10/2022] Open
Abstract
Background Rhabdomyomas comprise the majority of cardiac tumors in fetuses and are found in association with tuberous sclerosis complex. More than 90% of fetuses and neonates with multiple cardiac rhabdomyomas have signs of tuberous sclerosis complex. However, solitary cardiac rhabdomyoma cases are largely unrelated to tuberous sclerosis complex. Here, we report a case involving multiple cardiac rhabdomyomas not associated with tuberous sclerosis complex in a dizygotic twin. Case presentation A 36-year-old Japanese woman was diagnosed with a dizygotic twin pregnancy in the first trimester. Consistent with dizygosity, the fetal sex was discordant (male and female). At 27 weeks of gestation, hydrops and multiple echogenic cardiac masses were noted in the male baby, with the largest mass measuring 34 × 30 mm. The female fetus appeared normal. The cardiac masses enlarged gradually with the progression of the hydrops. At 32 weeks of gestation, intrauterine death of the male fetus was confirmed. The next day, autopsy of the male fetus was performed after cesarean section. Three well-demarcated white-tan-colored nodules were formed in the ventricular walls and interventricular septum, with the largest nodule (40 × 30 mm) in the left ventricular wall. Histologically, these lesions were diagnosed as rhabdomyomas. Conclusions We encountered a case involving multiple cardiac rhabdomyomas arising in one of dizygotic twin fetuses. Unlike most reported cases of multiple cardiac rhabdomyomas, this case was not accompanied by tuberous sclerosis complex. To the best of our knowledge, this is the first case report of multiple cardiac rhabdomyomas that developed in only one of dizygotic twins in the English literature.
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Affiliation(s)
- Koji Yamamoto
- Section of Oncopathology and Regenerative Biology, Department of Pathology, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, Japan.
| | - Yohei Maki
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Yuichiro Sato
- Department of Diagnostic Pathology, Miyazaki University Hospital, University of Miyazaki, Miyazaki, Japan
| | - Hiroyuki Tanaka
- Section of Oncopathology and Regenerative Biology, Department of Pathology, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, Japan.,Department of Diagnostic Pathology, Miyazaki University Hospital, University of Miyazaki, Miyazaki, Japan
| | - Tsuyoshi Fukushima
- Section of Oncopathology and Regenerative Biology, Department of Pathology, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, Japan
| | - Junko Ushijima
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Seishi Furukawa
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Hiroshi Sameshima
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Hiroaki Kataoka
- Section of Oncopathology and Regenerative Biology, Department of Pathology, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, Japan
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14
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Lefizelier E, Benbrik N, Bénéteau C, Le Vaillant C. Cardiac rhabdomyoma with hydrops fetalis: Prenatal management by abdominal drainage. Taiwan J Obstet Gynecol 2021; 60:551-553. [PMID: 33966747 DOI: 10.1016/j.tjog.2021.03.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE We described a case of fetal cardiac rhabdomyoma complicated by hydrops. And we discussed our approach during pregnancy. CASE REPORT A 23-year-old woman primigravida was referred at 29 weeks of gestation (WG) to prenatal unit for a large hyperechogenic intracardiac mass associated with fetal hydrops. An intrauterine peritoneo-amniotic shunt was placed. Complete regression of ascites and pericardial effusions were observed after 34 WG with drain in good position. CONCLUSION Cardiac rhabdomyoma is the most common prenatal cardiac tumor. These tumors are benign, asymptomatic and spontaneously regress after birth. However, in some cases, these tumors may cause severe obstructions on the fetal heart and need specific treatment.
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Affiliation(s)
- Emeline Lefizelier
- Department of Obstetrics and Gynecology, CHU Nantes, quai 38 bd Jean Monnet, 44093, Nantes Cedex, France
| | - Nadir Benbrik
- Department of Cardiology Pediatric, CHU Nantes, quai 38 bd Jean Monnet, 44093, Nantes Cedex, France
| | - Claire Bénéteau
- Department of Medical Genetics, CHU Nantes, quai 38 bd Jean Monnet, 44093, Nantes Cedex, France
| | - Claudine Le Vaillant
- Department of Obstetrics and Gynecology, CHU Nantes, quai 38 bd Jean Monnet, 44093, Nantes Cedex, France.
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15
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Abstract
Cardiac rhabdomyoma is a hamartoma comprised of cardiac myocytes. It is the classic cardiac manifestation of tuberous sclerosis complex (TSC) which is an autosomal dominant genetic syndrome with multi-organ involvement, but highly variable phenotype. Cardiac rhabdomyoma is most commonly diagnosed in infancy, 70 to 90% of whom have TSC. However, TSC-associated cardiac rhabdomyoma usually shows spontaneous regression within the first two years of life and hence is extremely rare in adults. We present a 34-year-old woman with TSC who was found to have a cardiac rhabdomyoma when she was referred to the cardiology clinic for evaluation and to establish care. Cardiac rhabdomyoma is usually asymptomatic. However, depending on size and location, it can cause outflow or inflow tract obstruction and aberrant electrical conduction. Hence, appropriate surveillance is important.
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Affiliation(s)
- Somshukla Ghosh
- Internal Medicine, University of Central Florida College of Medicine, Orlando, USA
| | - Mark R Milunski
- Cardiology, Orlando Veterans Affairs Medical Center, Orlando, USA
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16
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Knadler JJ, Lawrence E, Iacobas I, Justino H, Sheth S. Combination percutaneous and medical management of cardiac rhabdomyomas obstructing tricuspid valve inflow: Case report. J Neonatal Perinatal Med 2021; 14:143-148. [PMID: 32333554 DOI: 10.3233/npm-190330] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cardiac rhabdomyomas can be prenatally diagnosed in patients with tuberous sclerosis complex. Many neonates require no intervention in early life other than close monitoring for regression of tumor over the period of months to years. In rare instances, cardiac rhabdomyomas can result in obstruction to blood flow or decreased ventricular function. CASE REPORT We describe the case of a neonate who was prenatally diagnosed with multiple large cardiac rhabdomyomas, one of which caused clinically significant obstruction to prograde blood flow across the tricuspid valve in the newborn period. To address the disturbance to prograde pulmonary blood flow, the patient underwent successful ductal stent placement in the neonatal period. A troponin elevation was noted shortly after birth, but no evidence of coronary compression or involvement was demonstrated by coronary angiography. The patient has subsequently been treated with sirolimus over a period of three months, with noted regression in tumors and improvement in tricuspid valve inflow. CONCLUSIONS A brief review of the literature regarding the diagnosis, treatment, and management of neonatal patients with cardiac rhabdomyomas is presented. A combined percutaneous and medical management approach may be of benefit in future cases of rhabdomyomas causing obstruction to pulmonary blood flow.
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Affiliation(s)
- J J Knadler
- Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - E Lawrence
- Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - I Iacobas
- Section of Hematology/Oncology, Vascular Anomalies Center, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - H Justino
- Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - S Sheth
- Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
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17
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Beichl M, Thanhaeuser M, Ulm B, Zimpfer D. Successful surgical treatment of a 1160 g neonate with cardiac teratoma and severe foetal hydrops: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2021; 5:ytaa527. [PMID: 33738399 PMCID: PMC7954248 DOI: 10.1093/ehjcr/ytaa527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/10/2020] [Accepted: 12/01/2020] [Indexed: 11/22/2022]
Abstract
Background Prenatally diagnosed pericardial teratoma present a rare finding with an unfavourable prognosis due to frequently associated Foetal hydrops and limited treatment options. We report a successful surgical resection of a prenatally diagnosed cardiac teratoma in a 1160 g neonate with severe Foetal hydrops and cardiac deterioration. Case summary The patient was transferred in utero to our institution due to prior diagnosed pericardial mass and severe foetal hydrops, which necessitated caesarean section one day after arrival at a gestational age of 28 + 0 weeks. After intubation, the patient was stabilized by surgical drainage of 60 mL of pericardial effusion. Further clinical worsening of the patient on the day of life 12 demanded urgent intervention, so that in toto resection of the tumour was performed at a bodyweight of 1160 g. Histopathological analysis revealed a teratoma and the patient is in excellent clinical condition one year after surgery. Discussion This case report demonstrates that an interdisciplinary, two-staged approach can be a feasible and promising treatment option in patients with prenatally diagnosed teratoma and severe Foetal hydrops in a critical circulatory state. Furthermore, it illustrated that resection of pericardial masses can be successfully performed at a bodyweight as low as 1160 g.
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Affiliation(s)
- Matthias Beichl
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Cardiology, Medical University of Vienna, Austria
| | - Margarita Thanhaeuser
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University of Vienna, Austria
| | - Barbara Ulm
- Department of Obstetrics and Gynecology, Division of Feto-Maternal Medicine, Medical University of Vienna, Austria
| | - Daniel Zimpfer
- Department of Surgery, Division of Cardiac Surgery, Medical University of Vienna, Austria
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18
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Ding P, Qi J, Mo R, Sun J, Pen W, Wu K, Qian L, Mo X. Clinical Treatment of Pediatric Primary Cardiac Tumors: A Single-Institute 12-Year Experience. J Pediatr Hematol Oncol 2020; 42:488-494. [PMID: 31162296 DOI: 10.1097/mph.0000000000001520] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Primary cardiac tumors in children are extremely rare. This study aimed to analyze clinical treatment and follow-up of pediatric primary cardiac tumors. PATIENTS AND METHODS We performed a retrospective analysis by searching the medical records of 75 patients diagnosed with pediatric primary cardiac tumors from June 2005 to August 2017 in our institution. We followed operative patients every half year in the first postoperative year and then at least every year. If the patients had no serious symptoms or hemodynamic changes, they received nonoperative management and were followed regularly every year. RESULTS Nineteen patients underwent surgery at our department for serious symptoms and critical hemodynamic changes. Four patients had postoperative complications. Two died of low cardiac output syndrome and arrhythmia after surgery. One patient with myxomas had tumor recurrence and one had been found of another rhabdomyoma after surgery. The other 14 patients recovered well. Fifty-six patients had nonoperative management. Four were lost in follow-up. Two patients with malignant tumors died of unknown causes after discharge. The remaining patients had no severe symptoms or tumor growth during follow-up. CONCLUSIONS Clinical treatment of pediatric primary cardiac tumors should be performed individually. Most pediatric primary cardiac tumors are benign, and spontaneous regression is possible, especially for rhabdomyomas. The principle purpose of surgical treatment is to restore normal hemodynamics and protect important structures and cardiac tissue.
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Affiliation(s)
- Peicheng Ding
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University
| | - Jirong Qi
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University
| | - Ran Mo
- Department of Cardiothoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Medical School of Nanjing University, Nanjing, China
| | - Jian Sun
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University
| | - Wei Pen
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University
| | - Kaihong Wu
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University
| | - Longbao Qian
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University
| | - Xuming Mo
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University
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19
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Caicedo D, Oshiro K, Glickstein JS, Krishnan U, DiLorenzo MP. Cardiac Hemangioma in an Asymptomatic Teenager with a History of Congenital Heart Disease. CASE (PHILADELPHIA, PA.) 2020; 4:362-364. [PMID: 33117929 PMCID: PMC7581645 DOI: 10.1016/j.case.2020.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
• Cardiac hemangiomas constitute <10% of all pediatric cardiac tumors. • More than two thirds of patients with cardiac masses may present with symptoms. • Association between congenital heart disease and heart tumors is very uncommon. • Echocardiography is the first-line imaging modality for identifying cardiac masses. • CMR is an excellent imaging technique for cardiac tumor characterization.
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Affiliation(s)
- Daniel Caicedo
- Department of Pediatrics, Columbia University Medical Center/NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, New York
- Department of Pediatrics, Harlem Hospital Center, New York, New York
| | - Kristin Oshiro
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Medical Center/NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, New York
| | - Julie S Glickstein
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Medical Center/NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, New York
| | - Usha Krishnan
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Medical Center/NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, New York
| | - Michael P DiLorenzo
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Medical Center/NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, New York
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20
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Szczałuba K, Makuła E, Piórecka-Makuła A, Sicińska J, Rydzanicz M, Gasperowicz P, Płoski R, Werner B. Intracardiac tumor as a rare manifestation of genetic syndromes-presentation of a family with Gorlin syndrome and a literature review. J Appl Genet 2020; 61:559-565. [PMID: 32964316 PMCID: PMC7652740 DOI: 10.1007/s13353-020-00582-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/19/2020] [Accepted: 09/06/2020] [Indexed: 11/29/2022]
Abstract
Intracardiac tumors in children are relatively rare, but their clinical consequences may include severe outflow tract obstruction, embolism, cardiac insufficiency, or rhythm disturbances. In some cases, the tumor may constitute part of a genetic condition and prompt additional investigations, as well as a modification of therapeutic management. Herein, we present a molecularly confirmed familial case of Gorlin syndrome with an early cardiac tumor as a presenting sign. We provide detailed clinical characteristics of the affected individuals and a useful review of syndromic causes of pediatric cardiac tumors in clinical practice.
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Affiliation(s)
- Krzysztof Szczałuba
- Department of Medical Genetics, Medical University of Warsaw, ul Pawinskiego 3c, 02-106, Warsaw, Poland
| | - Ewa Makuła
- Medical University of Warsaw, Warsaw, Poland
| | - Anna Piórecka-Makuła
- Department of Pediatric Cardiology and General Pediatrics, Medical University of Warsaw, Warsaw, Poland
| | - Justyna Sicińska
- Clinical Department of Dermatology, Central Clinical Hospital of the MSWiA, Warsaw, Poland
| | - Małgorzata Rydzanicz
- Department of Medical Genetics, Medical University of Warsaw, ul Pawinskiego 3c, 02-106, Warsaw, Poland
| | - Piotr Gasperowicz
- Department of Medical Genetics, Medical University of Warsaw, ul Pawinskiego 3c, 02-106, Warsaw, Poland
| | - Rafał Płoski
- Department of Medical Genetics, Medical University of Warsaw, ul Pawinskiego 3c, 02-106, Warsaw, Poland.
| | - Bożena Werner
- Department of Pediatric Cardiology and General Pediatrics, Medical University of Warsaw, Warsaw, Poland
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21
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Azapagasi E, Uysal Yazici M, Ari ME, Karakaya RS, Cınar HG, Tasar M, Gucer S. Giant Right Atrial Myxoma with Fulminant Progression in an Infant. J Pediatr Intensive Care 2020; 11:77-82. [DOI: 10.1055/s-0040-1715849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 07/02/2020] [Indexed: 10/23/2022] Open
Abstract
AbstractCardiac myxoma is rare in children. Myxomas are exceedingly rare in infancy. Right atrial myxomas were recorded in a small number of case reports involving infants worldwide. We report the case of a 2-month-old infant with giant right atrial myxoma. The case presented to our hospital with respiratory distress, and had pericardial and pleural effusion. Diagnosis of cardiac tumor was made with the aid of computerized tomography scan and echocardiogram. The tumor size was 3.1 × 3.4 × 3.9 cm. The patient worsened rapidly and had sudden cardiac arrest which did not respond to interventions. Postmortem cardiac autopsy confirmed the diagnosis of myxoma on gross examination and histology. This article aims to focus attention to the atypical size and location of this atrial myxoma, causing diagnostic difficulty in this infant.
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Affiliation(s)
- Ebru Azapagasi
- Division of Pediatric Intensive Care Unit, Dr. Sami Ulus Maternity and Children’s Training and Research Hospital, Ankara, Turkey
| | - Mutlu Uysal Yazici
- Division of Pediatric Intensive Care Unit, Dr. Sami Ulus Maternity and Children’s Training and Research Hospital, Ankara, Turkey
| | - Mehmet Emre Ari
- Division of Pediatric Cardiology, Dr. Sami Ulus Maternity and Children’s Training and Research Hospital, Ankara, Turkey
| | | | - Hasibe Gökçe Cınar
- Department of Radiology, Dr. Sami Ulus Children’s Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Mehmet Tasar
- Department of Pediatric Cardiovascular Surgery, Dr. Sami Uĺus Chiĺdren’s Heaĺth and Diseases Training and Research Hospitaĺ, Ankara, Turkey
| | - Safak Gucer
- Departman of Pediatric Pathoĺogy, Hacettepe University Facuĺty of Medicine, Ankara, Turkey
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22
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Morka A, Kohut J, Radzymińska-Chruściel B, Mroczek T, Gładki M, Weryński P, Rudziński A, Skalski J, Szydłowski L. Echocardiography and Newer Imaging Techniques in Diagnosis and Long-Term Follow-Up of Primary Heart Tumors in Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155471. [PMID: 32751243 PMCID: PMC7432637 DOI: 10.3390/ijerph17155471] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 07/17/2020] [Accepted: 07/24/2020] [Indexed: 11/24/2022]
Abstract
Background: Primary heart tumors (PHTs) in the pediatric population are very rare and do not manifest any characteristic symptoms. Methods: A retrospective analysis of 61 cases was undertaken. Data from three centers for the years 2003–2018 were gathered. The tumors’ clinical course, location, number, hemodynamic, treatment, and follow-up were evaluated. Echocardiography was complemented with magnetic resonance imaging, computer tomography, and histopathological examination. Results: Out of 61 PHT diagnoses, 56 (91.8%) were circumstantial including all 16 (26.2%) prenatal tumors. The reasons for cardiological consultations were arrhythmia, syncopes, lowered physical performance, and murmurs. Only five patients (8.2%) were suspected of tumors based on previous symptoms of sclerosis tuberosa. Rhabdomyoma was the most frequently found PHT (60.7%). The tumors were predominantly located in the ventricles (49.1%) and intraventricular septum (14.9%) and tended to be single (70.5%). About 37.7% of patients suffered from coexistent multi-organ problems, two (3.28%) from congenital heart defects and one (1.64%) from Carney’s syndrome. Tumor resection was performed on 26 (42.7%) patients, of which 16 (61.5%) underwent total and 10 (38.5%) partial tumor resection. During the follow-up (mean 4.3 years), 54 patients (88.5%) have improved or were stable, while seven (11.5%) died. Conclusions: Primary pediatric heart tumors are diagnosed completely circumstantially, and the most common is rhabdomyoma, although arrhythmia may suggest fibroma. Diagnosis of a heart tumor in children is not synonymous with fatal prognosis, and most of them require only constant observation. Life-saving operation allows improvement, while the prognosis for malignant tumors in children is definitely unfavorable.
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Affiliation(s)
- Aleksandra Morka
- Department of Pediatric Cardiac Surgery, University Children’s Hospital, Faculty of Health Sciences, Jagiellonian University Medical College, 30-663 Kraków, Poland
- Correspondence:
| | - Joanna Kohut
- Department of Pediatric Cardiology, Faculty of Medical Sciences, Medical University of Silesia in Katowice, 40-752 Katowice, Poland; (J.K.); (L.S.)
| | | | - Tomasz Mroczek
- Department of Pediatric Cardiac Surgery, University Children’s Hospital, Faculty of Medicine, Jagiellonian University Medical College, 30-663 Kraków, Poland; (T.M.); (J.S.)
| | - Marcin Gładki
- Department of Pediatric Cardiac Surgery, University Children’s Hospital, 30-663 Kraków, Poland;
| | - Piotr Weryński
- Department of Pediatric Cardiology, University Children’s Hospital, Faculty of Medicine, Jagiellonian University Medical College, 30-663 Kraków, Poland; (P.W.); (A.R.)
| | - Andrzej Rudziński
- Department of Pediatric Cardiology, University Children’s Hospital, Faculty of Medicine, Jagiellonian University Medical College, 30-663 Kraków, Poland; (P.W.); (A.R.)
| | - Janusz Skalski
- Department of Pediatric Cardiac Surgery, University Children’s Hospital, Faculty of Medicine, Jagiellonian University Medical College, 30-663 Kraków, Poland; (T.M.); (J.S.)
| | - Lesław Szydłowski
- Department of Pediatric Cardiology, Faculty of Medical Sciences, Medical University of Silesia in Katowice, 40-752 Katowice, Poland; (J.K.); (L.S.)
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23
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Abstract
Primary malignant neoplasms of the heart are rare. Cardiac rhabdomyosarcoma is the second most common primary sarcoma. We report a rare case of a 49-year-old woman with a huge biatrial cardiac rhabdomyosarcoma treated by performing surgical resection followed by salvage chemotherapy for local recurrence. Cardiac sarcoma that occupy both atria are extremely rare. Although the prognosis of cardiac rhabdomyosarcoma is dismal, surgical resection should be recommended as a first line therapy to clarify the diagnosis and to relieve symptoms associated with the tumor.
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Affiliation(s)
- Tetsuro Uchida
- Yamagata University Faculty of Medicine Second Department of Surgery Yamagata Japan Second Department of Surgery, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Yoshinori Kuroda
- Yamagata University Faculty of Medicine Second Department of Surgery Yamagata Japan Second Department of Surgery, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Mitsuaki Sadahiro
- Yamagata University Faculty of Medicine Second Department of Surgery Yamagata Japan Second Department of Surgery, Faculty of Medicine, Yamagata University, Yamagata, Japan
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24
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Abstract
Phakomatoses present with characteristic findings on the skin, central or peripheral nervous system, and tumors. Neurofibromatosis type 1 is the most common syndrome and is characterized by Café-au-lait macules, intertriginous freckling, Lisch nodules, and tumors including neurofibromas, malignant peripheral nerve sheath tumors, and gliomas. Tuberous Sclerosis Complex is characterized by benign hamartomas presenting with hypomelanotic macules, shagreen patches, angiofibromas, confetti lesions and tumors including cortical tubers, subependymal nodules, subependymal giant cell astrocytomas and tumors of the kidney, lung, and heart. Managing these disorders requires disease specific supportive care, tumor monitoring, surveillance for selected cancers, and treatment of comorbid conditions.
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Affiliation(s)
- Benjamin Becker
- Department of Neurology, Wake Forest Baptist Health, 1 Medical Center Boulevard, Winston Salem, NC 27157, USA.
| | - Roy E Strowd
- Department of Neurology, Wake Forest Baptist Health, 1 Medical Center Boulevard, Winston Salem, NC 27157, USA; Department of Internal Medicine, Section on Hematology and Oncology, Wake Forest Baptist Health, Winston Salem, NC 27157, USA; Translational Science Institute, Wake Forest Baptist Health, Winston Salem, NC 27157, USA
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25
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Alnoman A, Spiegel E, Bernier PL, Brown R. Prenatal and postnatal imaging of an intrapericardial teratoma. CASE REPORTS IN PERINATAL MEDICINE 2020. [DOI: 10.1515/crpm-2019-0061] [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]
Abstract
Abstract
Background
Intrapericardial teratomas are rare tumors arising from all three germinal layers. They are mostly benign but can lead to life-threatening complications.
Case presentation
A 38-year-old woman with an in vitro fertilization (IVF) conception had a normal fetal anatomical survey at 20 weeks of gestation. At 32 weeks, during evaluation for decreased fetal movements and gestational diabetes, the fetus was found to have a unilateral right pleural effusion, a large pericardial effusion with an 18 × 16 × 17 mm-sized cystic intrapericardial mass and ventricular dysfunction with associated, significant, polyhydramnios. Echocardiography was suggestive of a teratoma which was confirmed by pathology after postnatal surgery.
Conclusion
Early prenatal diagnosis and appropriate monitoring during pregnancy are important to optimize outcome, however, even though antenatal intervention may improve the outcome in cases with hydrops, in utero mortality remains high.
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Affiliation(s)
- Abdullah Alnoman
- Department of Obstetrics and Gynecology , McGill University , Montreal , Quebec , Canada
- King Abdulaziz University , Jeddah , Saudi Arabia
| | - Efrat Spiegel
- Department of Maternal Fetal Medicine , McGill University , Montreal , Quebec , Canada
| | - Pierre-Luc Bernier
- Department of Paediatric Cardiac Surgery , McGill University , Montreal , Quebec , Canada
| | - Richard Brown
- Department of Obstetrics and Gynecology , McGill University , Montreal , Quebec , Canada
- Department of Maternal Fetal Medicine , McGill University , Montreal , Quebec , Canada
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26
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Pluym ID, Sklansky M, Wu JY, Afshar Y, Holliman K, Devore GR, Walden A, Platt LD, Krakow D. Fetal cardiac rhabdomyomas treated with maternal sirolimus. Prenat Diagn 2020; 40:358-364. [PMID: 31742705 DOI: 10.1002/pd.5613] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 10/25/2019] [Accepted: 10/30/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To review the pathophysiology of rhabdomyomas and the emerging option of prenatal treatment of fetal cardiac rhabdomyomas. METHODS We present a case of fetal rhabdomyomas causing significant hemodynamic compromise that received in utero treatment of maternal sirolimus. Genetic amniocentesis confirmed a TSC2 mutation. A treatment program was initiated with a 10-mg loading dose titrated to a goal maternal trough of 10 to 15 ng/dL. In order to follow fetal cardiac function, a sophisticated method of speckle tracking echocardiography was used before and after treatment. Obstetric ultrasound was used to monitor fetal growth, and clinical surveillance, echocardiography, and brain MRI were used to monitor postnatal growth and development through 6 months of neonatal life. RESULTS Sirolimus was initiated from 28 to 36 weeks of gestation with improvement of cardiac status. During this period, intrauterine growth restriction developed. Postnatally, the infant has had stable rhabdomyomas and cardiac function without reinitiating sirolimus. Brain MRI demonstrated scattered cortical tubers and subependymal nodules, and the infant has not had seizure-like activity. At 6 months of age, the infant has achieved appropriate developmental milestones. CONCLUSION In counseling cases of prenatal onset large obstructing rhabdomyomas and cardiac compromise, in utero sirolimus treatment can be considered.
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Affiliation(s)
- Ilina D Pluym
- Department of Obstetrics and Gynecology, University of California at Los Angeles, Los Angeles, CA
| | - Mark Sklansky
- Department of Pediatrics, UCLA, Mattel Children's Hospital, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Joyce Y Wu
- Division of Pediatric Neurology, Department of Pediatrics, University of California at Los Angeles, Los Angeles, CA
| | - Yalda Afshar
- Department of Obstetrics and Gynecology, University of California at Los Angeles, Los Angeles, CA
| | - Kerry Holliman
- Department of Obstetrics and Gynecology, University of California at Los Angeles, Los Angeles, CA
| | - Greggory R Devore
- Department of Obstetrics and Gynecology, University of California at Los Angeles, Los Angeles, CA.,Fetal Diagnostic Centers, Pasadena, CA
| | | | - Lawrence D Platt
- Department of Obstetrics and Gynecology, University of California at Los Angeles, Los Angeles, CA.,Center for Fetal Medicine and Women's Ultrasound, Los Angeles, CA
| | - Deborah Krakow
- Department of Obstetrics and Gynecology, University of California at Los Angeles, Los Angeles, CA.,Department of Pediatrics, UCLA, Mattel Children's Hospital, David Geffen School of Medicine at UCLA, Los Angeles, CA.,Department of Human Genetics, University of California at Los Angeles, Los Angeles, CA.,Department of Orthopaedic Surgery, University of California at Los Angeles, Los Angeles, CA
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27
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Successful intrauterine treatment of nonimmune hydrops fetalis due to pericardial tumor. MARMARA MEDICAL JOURNAL 2019. [DOI: 10.5472/marumj.570917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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28
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Garg A, Gorla SR, Kardon RE, Swaminathan S. Rapid Involution of Large Cardiac Rhabdomyomas With Everolimus Therapy. World J Pediatr Congenit Heart Surg 2019; 12:426-429. [PMID: 31072227 DOI: 10.1177/2150135118822711] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Rhabdomyoma of the fetal heart is a rare disease accounting for about 1% of all fetal cardiac structural anomalies. They are often found in association with tuberous sclerosis complex. Large cardiac rhabdomyomas can compromise the cardiac function. We report a case of multiple large rhabdomyomas of the right and left ventricles, affecting the cardiac function, which was successfully treated with the chemotherapeutic and immunosuppressive medication everolimus, in a neonate with genetically confirmed tuberous sclerosis complex with multisystem manifestations. There was rapid involution of the tumors in response to everolimus therapy in this infant.
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Affiliation(s)
- Ashish Garg
- Division of Pediatric Cardiology, Holtz Children's Hospital, Jackson Memorial Medical Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sudheer R Gorla
- Division of Pediatric Cardiology, Holtz Children's Hospital, Jackson Memorial Medical Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Richard E Kardon
- Division of Pediatric Cardiology, Holtz Children's Hospital, Jackson Memorial Medical Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sethuraman Swaminathan
- Division of Pediatric Cardiology, Holtz Children's Hospital, Jackson Memorial Medical Center, University of Miami Miller School of Medicine, Miami, FL, USA
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29
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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.
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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
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30
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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.
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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.
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31
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Large Cardiac Fibroma – A Case Report of Sudden Death in A 10-Year-Old Child. JOURNAL OF CARDIOVASCULAR EMERGENCIES 2018. [DOI: 10.2478/jce-2018-0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT
Introduction: Cardiac fibroma is a rare benign tumor, although it is considered the second most frequent cardiac tumor in children. It is located in the ventricular myocardium, frequently in the interventricular septum. One third of the cases are asymptomatic, being discovered postmortem. Case presentation: A 10-year-old male child accused severe dyspnea a few minutes before its sudden death. Autopsy examination revealed hypertrophic cardiomegaly, the entire left ventricular wall being replaced by an enlarged tumor mass. On histopathological examination, the tumor was diagnosed as cardiac fibroma. Conclusions: Noninvasive examinations during childhood, such as cardiac ultrasound, increase the early detection of the tumors of the heart, decreasing the number of sudden death cases in young patients, especially children.
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Abstract
Giant cardiac rhabdomyomas were identified on fetal echocardiography. The rhabdomyomas were unusually located in the pericardial space. Rapid regression and hemodynamic improvement were seen with sirolimus therapy.
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33
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Giant Rhabdomyoma Requiring Emergency Resection Early After Birth. Ann Thorac Surg 2018; 107:e65. [PMID: 30009805 DOI: 10.1016/j.athoracsur.2018.05.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 05/30/2018] [Indexed: 11/24/2022]
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34
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Gu X, Han L, Chen J, Wang J, Hao X, Zhang Y, Zhang J, Ge S, He Y. Antenatal screening and diagnosis of tuberous sclerosis complex by fetal echocardiography and targeted genomic sequencing. Medicine (Baltimore) 2018; 97:e0112. [PMID: 29642139 PMCID: PMC5908597 DOI: 10.1097/md.0000000000010112] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Although fetal cardiac rhabdomyoma can be the initial finding in patients with tuberous sclerosis complex (TSC), the challenges of precise genetic diagnosis of TSC can now be potentially overcome by new whole or targeted genomic sequencing. The goals of this study were to investigate the correlation between suspected cardiac rhabdomyoma and TSC to provide the information for a prenatal diagnosis of TSC and to validate the TSC genotype in this cohort of fetuses with suspected prenatal cardiac rhabdomyoma.We retrospectively analyzed 10,728 fetal echocardiograms from January 2013 to March 2016 in our institution. A total of 32 fetuses were suspected of having cardiac rhabdomyomas. Among them, 15 subjects met the inclusion criteria and provided written consent. Samples from fetuses (n = 13 after terminations) and newborns (n = 2) were available for targeted genomic sequencing of the exons and introns of the TSC1 and TSC2 genes and the adjacent 10 base pairs and for validated studies using Sanger sequencing.Among the 15 subjects with suspected cardiac rhabdomyoma and TSC genomic sequencing data, 7 subjects were familial and 8 subjects were sporadic cases. Fetal echocardiography showed a single tumor in 2 fetuses and multiple tumors in 13 fetuses. Gene sequencing analysis showed no mutation of the TSC1 or TSC2 gene in 2 subjects with a single tumor but positive mutations in all 13 subjects with multiple tumors. Among the latter, 5 mutations were "pathogenic" and have been previously reported (4 familial and 1 sporadic). Six new mutations were "likely pathogenic" and had not been previously reported (3 familial and 3 sporadic); 1 was of "uncertain significance" (sporadic), and 1 was suspected of being "likely benign" (sporadic).Prenatal suspected cardiac rhabdomyoma detected by fetal echocardiography should raise the suspicion of TSC. In fetuses with multiple tumors, especially the familial cases, genomic sequencing has a high yield of detecting TSC-causing genes. Patient history, prenatal fetal echocardiography, and targeted genomic sequencing may facilitate screening for, diagnosis of, and counseling for TSC.
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Affiliation(s)
- Xiaoyan Gu
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing Key Laboratory of Maternal-Fetal Medicine in Fetal Heart Disease
| | - Ling Han
- Department of Pediatrics, Beijing Anzhen Hospital, Capital Medical University
| | - Jian Chen
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing Key Laboratory of Maternal-Fetal Medicine in Fetal Heart Disease
| | | | - Xiaoyan Hao
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing Key Laboratory of Maternal-Fetal Medicine in Fetal Heart Disease
| | - Ye Zhang
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing Key Laboratory of Maternal-Fetal Medicine in Fetal Heart Disease
| | - Jun Zhang
- The Department of Gynecology and Obstetrics, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Shuping Ge
- The Heart Center, St. Christopher's Hospital for Children and Drexel University College of Medicine, Philadelphia, PA
| | - Yihua He
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing Key Laboratory of Maternal-Fetal Medicine in Fetal Heart Disease
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35
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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.
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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
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36
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Ide T, Miyoshi T, Katsuragi S, Neki R, Kurosaki KI, Shiraishi I, Yoshimatsu J, Ikeda T. Prediction of postnatal arrhythmia in fetuses with cardiac rhabdomyoma. J Matern Fetal Neonatal Med 2018; 32:2463-2468. [DOI: 10.1080/14767058.2018.1438402] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Tetsuya Ide
- Department of Perinatology and Gynecology, Suita, Japan
| | - Takekazu Miyoshi
- Department of Perinatology and Gynecology, Suita, Japan
- Department of Obstetrics and Gynecology, Mie University, Tsu, Japan
| | | | - Reiko Neki
- Department of Perinatology and Gynecology, Suita, Japan
| | - Ken-ichi Kurosaki
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Isao Shiraishi
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Suita, Japan
| | | | - Tomoaki Ikeda
- Department of Obstetrics and Gynecology, Mie University, Tsu, Japan
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37
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Spontaneous Regression of Cardiac Rhabdomyoma Presenting as Severe Left Ventricular Inlet Obstruction in a Neonate with Tuberous Sclerosis. Case Rep Cardiol 2018; 2018:8395260. [PMID: 29619257 PMCID: PMC5829321 DOI: 10.1155/2018/8395260] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Accepted: 11/27/2017] [Indexed: 11/17/2022] Open
Abstract
Cardiac rhabdomyoma can be subclinical or have a fatal presentation according to the onset age and involved site, size, and degree of invasion. Although most cardiac rhabdomyomas become smaller with time, emergency intervention is indicated when severe obstruction has occurred. In this report, we describe the spontaneous regression of a large cardiac rhabdomyoma (20.5 × 15.6 mm) presenting as severe left ventricular inlet obstruction in a neonate with tuberous sclerosis. Although a cardiac rhabdomyoma can be large enough to induce left ventricular inlet obstruction, conservative treatment without aggressive surgical intervention can be considered if the hemodynamic condition does not deteriorate.
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38
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Chikkabyrappa SM, Tretter JT, Vishwanath V, Bhatla P. "Chorea": A Unique Presentation of Left Atrial Myxoma in a Pediatric Patient. World J Pediatr Congenit Heart Surg 2017; 11:NP11-NP13. [PMID: 29187022 DOI: 10.1177/2150135117690109] [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: 11/17/2022]
Abstract
We report an unusual presentation of a large left atrial myxoma in an eight-year-old girl who presented with the sudden onset of chorea. This case illustrates the fact that the presentation of chorea in nonendemic areas for rheumatic fever should raise suspicion for a myxoma. The chorea resolved soon after removal of the myxoma, supporting the hypothesis of an immune-mediated mechanism, or manifestation of paraneoplastic syndrome secondary to the myxoma.
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Affiliation(s)
- Sathish M Chikkabyrappa
- Division of Pediatric Cardiology, New York University Langone Medical Center, New York, NY, USA
| | - Justin T Tretter
- Division of Pediatric Cardiology, New York University Langone Medical Center, New York, NY, USA
| | - Vijay Vishwanath
- Division of Pediatric Neurology, New York University Langone Medical Center, New York, NY, USA
| | - Puneet Bhatla
- Division of Pediatric Cardiology, New York University Langone Medical Center, New York, NY, USA
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39
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Nassr AA, Shazly SA, Morris SA, Ayres N, Espinoza J, Erfani H, Olutoye OA, Sexson SK, Olutoye OO, Fraser CD, Belfort MA, Shamshirsaz AA. Prenatal management of fetal intrapericardial teratoma: a systematic review. Prenat Diagn 2017; 37:849-863. [DOI: 10.1002/pd.5113] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 07/05/2017] [Accepted: 07/06/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Ahmed A. Nassr
- Department of Obstetrics and Gynecology; Baylor College of Medicine and Texas Children's Fetal Center; Houston TX USA
- Women's Health Hospital; Assiut University; Assiut Egypt
| | - Sherif A. Shazly
- Department of Obstetrics and Gynecology; Mayo Clinic College of Medicine; Rochester MN USA
| | - Shaine A. Morris
- Division of Pediatric Cardiology; Baylor College of Medicine and Texas Children's Fetal Center; Houston TX USA
| | - Nancy Ayres
- Division of Pediatric Cardiology; Baylor College of Medicine and Texas Children's Fetal Center; Houston TX USA
| | - Jimmy Espinoza
- Department of Obstetrics and Gynecology; Baylor College of Medicine and Texas Children's Fetal Center; Houston TX USA
| | - Hadi Erfani
- Department of Obstetrics and Gynecology; Baylor College of Medicine and Texas Children's Fetal Center; Houston TX USA
| | - Olutoyin A. Olutoye
- Division of Pediatric Anesthesia; Baylor College of Medicine and Texas Children's Fetal Center; Houston TX USA
| | - Sara K. Sexson
- Division of Pediatric Cardiology; Baylor College of Medicine and Texas Children's Fetal Center; Houston TX USA
| | - Oluyinka O. Olutoye
- Division of Pediatric Surgery; Baylor College of Medicine and Texas Children's Fetal Center; Houston TX USA
| | - Charles D. Fraser
- Division of Congenital Heart Surgery; Baylor College of Medicine and Texas Children's Heart Center; Houston TX USA
| | - Michael A. Belfort
- Department of Obstetrics and Gynecology; Baylor College of Medicine and Texas Children's Fetal Center; Houston TX USA
| | - Alireza A. Shamshirsaz
- Department of Obstetrics and Gynecology; Baylor College of Medicine and Texas Children's Fetal Center; Houston TX USA
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40
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Wataya-Kaneda M, Uemura M, Fujita K, Hirata H, Osuga K, Kagitani-Shimono K, Nonomura N. Tuberous sclerosis complex: Recent advances in manifestations and therapy. Int J Urol 2017; 24:681-691. [DOI: 10.1111/iju.13390] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 05/01/2017] [Indexed: 01/02/2023]
Affiliation(s)
- Mari Wataya-Kaneda
- Department of Dermatology; Graduate School of Medicine; Osaka University; Suita Osaka Japan
| | - Motohide Uemura
- Department of Urology; Graduate School of Medicine; Osaka University; Suita Osaka Japan
| | - Kazutoshi Fujita
- Department of Urology; Graduate School of Medicine; Osaka University; Suita Osaka Japan
| | - Haruhiko Hirata
- Department of Respiratory Medicine; Allergy and Rheumatic Diseases; Graduate School of Medicine; Osaka University; Suita Osaka Japan
| | - Keigo Osuga
- Department of Diagnostic and Interventional Radiology; Graduate School of Medicine; Osaka University; Suita Osaka Japan
| | - Kuriko Kagitani-Shimono
- Department of United Graduate School of Child Development; Osaka University; Suita Osaka Japan
| | - Norio Nonomura
- Department of Urology; Graduate School of Medicine; Osaka University; Suita Osaka Japan
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Abstract
Cardiac haemangiomas are exceedingly rare; however, they can cause significant haemodynamic impairment and disturbances in heart rhythm. Rarely, cardiac tumours may also coexist with congenital heart lesions. We present an extremely unusual case of a cardiac haemangioma in the setting of complex transposition of the great arteries that caused functional tricuspid atresia. To our knowledge, this is the first such case described in the literature.
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42
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Bejiqi R, Retkoceri R, Xhema-Bejiqi H, Bejiqi R, Maloku A. A Giant Heart Tumor in Neonate with Clinical Signs of Pierre - Robin Syndrome. Med Arch 2017; 71:141-143. [PMID: 28790548 PMCID: PMC5511525 DOI: 10.5455/medarh.2017.71.141-143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Accepted: 03/25/2017] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Pierre Robin syndrome is a congenital condition of facial abnormalities in humans. The three main features are: cleft palate, retrognathia and glossoptosis. Rarely heart tumors are associated with syndromes, mostly are isolated. CASE REPORT In this presentation we describe a 3-weeks-old girl with Pierre-Robin syndrome and giant left ventricle tumor, diagnosed initially by transthoracic echocardiography. The purpose of this report is to review the literature on the fetuses and neonates with cardiac tumors in an attempt to determine the various ways which cardiac tumors differ clinically and morphologically in this age group.
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Affiliation(s)
- Ramush Bejiqi
- University of Gjakova, Division of Cardiology, Pediatric Clinic, University Clinical Centre of Kosovo, Prishtina, Republic of Kosovo
| | - Ragip Retkoceri
- University of Gjakova, Division of Cardiology, Pediatric Clinic, University Clinical Centre of Kosovo, Prishtina, Republic of Kosovo
| | | | - Rinor Bejiqi
- Medical School, University of Prishtina, Prishtina, Republic of Kosovo
| | - Arlinda Maloku
- University of Gjakova, Division of Cardiology, Pediatric Clinic, University Clinical Centre of Kosovo, Prishtina, Republic of Kosovo
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Remadi JP, Abdallah L, Tribouilloy C. Huge Cardiac Myxoma. Ann Thorac Surg 2017; 103:e373. [PMID: 28359503 DOI: 10.1016/j.athoracsur.2016.11.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 11/12/2016] [Accepted: 11/15/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Jean Paul Remadi
- Service de Chirurgie Cardiaque, Amiens Hopital Sud, Amiens, France.
| | - Layal Abdallah
- INSERM, ERI 12, and University Hospital, Department of Cardiology, Amiens, France
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Bejiqi R, Retkoceri R, Bejiqi H. Prenatally Diagnosis and Outcome of Fetuses with Cardiac Rhabdomyoma - Single Centre Experience. Open Access Maced J Med Sci 2017; 5:193-196. [PMID: 28507627 PMCID: PMC5420773 DOI: 10.3889/oamjms.2017.040] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 02/22/2017] [Accepted: 02/24/2017] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Cardiac rhabdomyoma (CRs) are the most common primary tumour of the heart in infants and children. Usually are multiple and, basing on the location can cause a haemodynamic disturbance, dysrhythmias or heart failure during the fetal and early postnatal period. CRs have a natural history of spontaneous regression and are closely associated with tuberous sclerosis complex (TSC). It has an association with tuberous sclerosis (TS), and in those, the tumour may regress and disappear completely, or remain consistent in size. AIM We aimed to evaluate the prenatal diagnosis, clinical presentation and outcome of CRs and their association with TSC in a single centre. The median follow-up period was three years (range: 6 months - 5 years). MATERIAL AND METHODS We reviewed medical records of all fetuses diagnosed prenatally with cardiac rhabdomyoma covering the period January 2010 to December 2016 which had undergone detailed ultrasound evaluation at a single centre with limited technical resources. RESULTS Twelve fetuses were included in the study; mostly had multiple tumours and a total of 53 tumours were identified in all patients - the maximum was one fetus with16 tumours. All patients were diagnosed prenatally by fetal echocardiography. In two patient's haemodynamic disturbances during the fetal period was noted and pregnancies have been terminated. After long consultation termination of pregnancy was chosen by the parents in totally 8 cases. In four continuing pregnancies during the first year of live tumours regressed. TSC was diagnosed in all patients during the follow-up. CONCLUSIONS Cardiac rhabdomyoma are benign from the cardiovascular standpoint in most affected fetuses. An early prenatal diagnosis may help for an adequate planning of perinatal monitoring and treatment with the involvement of a multidisciplinary team. Large tumour size, the number of tumours and localisation may cause hydrops, and they are significantly associated with poor neonatal outcome.
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Affiliation(s)
- Ramush Bejiqi
- Division of Cardiology, Pediatric Clinic, University Clinical Center of Kosovo, Prishtina, Kosovo
| | - Ragip Retkoceri
- Division of Cardiology, Pediatric Clinic, University Clinical Center of Kosovo, Prishtina, Kosovo
| | - Hana Bejiqi
- Main Center of Family Medicine, Prishtina, Kosovo
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Bao M, Zheng C, Zhang H, Ruan Y, Cao A, Wu T, Luo YI. Inflammatory myofibroblastic tumor of the left atrium in infant. Int J Cardiol 2016; 222:965-967. [DOI: 10.1016/j.ijcard.2016.08.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 08/02/2016] [Indexed: 10/21/2022]
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Rabdomioma fetal: diagnóstico prenatal y tratamiento. REVISTA COLOMBIANA DE CARDIOLOGÍA 2016. [DOI: 10.1016/j.rccar.2016.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Macaya A, Torra R, Ariceta G, Boronat S, Plana JC, Espinosa ÁC, García-Miñaúr S, Hernández-Martín Á, Krueger DA, López-Pisón J, Palomo Castaño YA, Hermogenes F, Crespo ER, Ruiz-Falcó Rojas ML, Serrano-Castro PJ, Auba FV. Recomendaciones para el abordaje multidisciplinar del complejo esclerosis tuberosa. Med Clin (Barc) 2016; 147:211-216. [DOI: 10.1016/j.medcli.2016.04.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 04/04/2016] [Accepted: 04/05/2016] [Indexed: 11/17/2022]
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Ramadani N, Kreshnike KD, Muçaj S, Kabashi S, Hoxhaj A, Jerliu N, Bejiçi R. MRI Verification of a Case of Huge Infantile Rhabdomyoma. Acta Inform Med 2016; 24:146-8. [PMID: 27147810 PMCID: PMC4851540 DOI: 10.5455/aim.2016.24.146-148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 03/11/2016] [Indexed: 11/29/2022] Open
Abstract
Introduction: Cardiac rhabdomyoma is type of benign myocardial tumor that is the most common fetal cardiac tumor. Cardiac rhabdomyomas are usually detected before birth or during the first year of life. They account for over 60% of all primary cardiac tumors. Case report: A 6 month old child with coughing and obstruction in breathing, was hospitalized in the Pediatric Clinic in UCCK, Pristine. The difficulty of breathing was heard and the pathological noise of the heart was noticed from the pediatrician. In the echo of the heart at the posterior and apico-lateral part of the left ventricle a tumoral mass was presented with the dimensions of 56 × 54 mm that forwarded the contractions of the left ventricle, the mass involved also the left ventricle wall and was not vascularized. The right ventricle was deformed and with the shifting of the SIV on the right the contractility was preserved. Aorta, the left arch and AP were normal with laminar circulation. The pericard was presented free. Radiography of thoracic organs was made; it resulted on cardiomegaly and significant bronchovascular drawing. It was completed with an MRI and it resulted on: Cardiomegaly due to large tumoral mass lesion (60×34 mm) involving lateral wall of left ventricle. It was isointense to the muscle on T1W images, markedly hyperintense on T2W images. There were a few septa or bant like hypointensities within lesion. On postcontrast study it showed avid enhancement. The left ventricle volume was decreased. Mild pericardial effusion was also noted. Surgical intervention was performed and it resulted on the histopathological aspect as a huge infantile rhadbomyoma. Conclusion: In most cases no treatment is required and these lesions regress spontaneously. Patients with left ventricular outflow tract obstruction or refractory arrhythmias respond well to surgical excision. Rhabdomyomas are frequently diagnosed by means of fetal echocardiography during the prenatal period.
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Affiliation(s)
- Naser Ramadani
- Faculty of Medicine, Pristine University, Pristine, Kosovo; National Institute of Public Health of Kosovo, Pristine, Kosovo
| | - Kreshnike Dedushi Kreshnike
- Faculty of Medicine, Pristine University, Pristine, Kosovo; Department of Radiology, Diagnostic Centre, UCCK, Pristine, Kosovo; International Health Center "IHC" Pristine, Kosovo
| | - Sefedin Muçaj
- Faculty of Medicine, Pristine University, Pristine, Kosovo; National Institute of Public Health of Kosovo, Pristine, Kosovo
| | - Serbeze Kabashi
- Faculty of Medicine, Pristine University, Pristine, Kosovo; Department of Radiology, Diagnostic Centre, UCCK, Pristine, Kosovo
| | | | - Naim Jerliu
- Faculty of Medicine, Pristine University, Pristine, Kosovo; National Institute of Public Health of Kosovo, Pristine, Kosovo
| | - Ramush Bejiçi
- Faculty of Medicine, Pristine University, Pristine, Kosovo; Pediatric Clinic, Department of Cardiology UCCK, Pristine, Kosovo
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Maddali MM, Al-Farqani A, Subbaraya Kandachar P, Thomas E, Mohsen A. A Rare Cause of Cyanosis in a Neonate. J Cardiothorac Vasc Anesth 2016; 30:561-3. [DOI: 10.1053/j.jvca.2015.07.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Indexed: 11/11/2022]
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Goel R, Aggarwal N, Lemmon ME, Bosemani T. Fetal and maternal manifestations of tuberous sclerosis complex: Value of fetal MRI. Neuroradiol J 2016; 29:57-60. [PMID: 26838171 DOI: 10.1177/1971400915621323] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Tuberous sclerosis complex (TSC) is a genetic disorder characterized by benign hamartomas in various organ systems of the body. Prenatal screening of fetuses of mothers affected with TSC using ultrasonography (US) may detect cardiac lesions. Fetal US is not sensitive for evaluation of the brain. We describe brain MRI findings in a fetus with cardiac rhabdomyomas identified on prenatal screening US. Postnatal brain MRI at 5 days of age demonstrated fetal MRI findings without significant added information. Fetal MRI is the imaging modality of choice for evaluation of cerebral manifestations of TSC. Maternal manifestations of TSC in the abdomen or pelvis may also be demonstrated on fetal MRI.
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Affiliation(s)
- Reema Goel
- Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, USA
| | - Nishant Aggarwal
- Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, USA
| | - Monica E Lemmon
- Department of Neurology, The Johns Hopkins University School of Medicine, USA Neurosciences Intensive Care Nursery, The Johns Hopkins University School of Medicine, USA
| | - Thangamadhan Bosemani
- Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, USA Neurosciences Intensive Care Nursery, The Johns Hopkins University School of Medicine, USA
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