Fetal Cardiac Tumors
Pp. 36-51 (16)
Fetal cardiac tumors (FCT) are rare anomalies (about 1% among prenatal
cardiac problems). There are more frequent multiple FCT and less frequent single FCT.
The FCT occur in the population of healthy young mothers and risk factors are not
easily detectable, but environmental factors (benzapirin?) could play a role. Basic
ultrasound (US) anatomy in the 1st and 2nd trimester usually is normal and FCT are
usually detected in the second half of pregnancy. In the majority of cases the fetus’s
growth is normal. In each case, targeted fetal echocardiography should be performed in
a fetal cardiology center. The very first problem is to discriminate between normal
heart anatomy and congenital heart defect. The second goal of fetal echocardiography
in FCT is to make an assessment of the hemodynamic status of the fetus. Extracardiac
and additional anomalies coexisting in cases of FTC can be divided into two types i.e.,
frequent and rare. An experienced fetal cardiologist can not only make a proper
diagnosis but also should counsel parents about the short-term prognosis for the fetus
(about his future during prenatal life) as well as long term prognosis (after birth and
later on). In cases of maternal decision to continue the pregnancy, fetal
echocardiography monitoring should be offered to evaluate possible hemodynamic
changes, to prepare both fetus and pregnant woman for optimal time for delivery and
perinatal care. The main goal would be to avoid prematurity and to confirm fetal wellbeing,
despite the cardiac abnormality. Details of echocardiography and postnatal
outcome are presented in rhabdomyoma, teratoma, fibroma, myxoma and hemangioma.
The way of delivery in surgical resection of cardiac tumors in newborns is discussed. In
differential diagnosis, “bright spot” is discussed. Suggested management – algorithm of
perinatal care in cases of FCT is presented with emphasis on cooperation of a perinatal
team. FCT can be diagnosed at 20 weeks of pregnancy, which allows to start
echocardiographic monitoring, taking into consideration the potential risk of
hemodynamic progression. FCT (both multiple and single) can be the first sign of
tuberous sclerosis complex in later prenatal or postnatal life. Single FCT other than
rhabdomyoma can be asymptomatic in newborns, but may require an early surgical
resection, therefore delivery in tertiary centers is recommended. FCT are a good
example of the practical value of prenatal cardiology development.
Differential diagnosis, Fibroma, Myxoma and Hemangioma, Perinatal
management, Rhabdomyoma, Teratoma, Type of delivery.
Fetal Malformations and Prevention Department, Medical University of Lodz, Poland.