Diagnosis and management of fetal cardiac tumors: a multicenter experience and review of published reports

Children's National Medical Center, Washington, D.C., USA.

OBJECTIVES. We sought to determine the prevalence and natural history of cardiac tumors in patients referred for fetal echocardiography. BACKGROUND. Cardiac tumors are rare; the prevalence, reported from autopsy studies of patients of all ages, varies from 0.0017% to 0.28%. Despite many case reports, the prevalence and natural history of fetal cardiac tumors are unclear. METHODS. Fourteen thousand fetal echocardiograms recorded over an 8-year period in seven centers were available for retrospective review. Medical records and echocardiograms were studied to determine the reason for referral, family history of tuberous sclerosis, prenatal and postnatal course and tumor description and type. RESULTS. Cardiac tumors were present in 19 pregnancies (0.14%). Gestational age at diagnosis ranged from 21 to 38 weeks. The most common indication for referral was a mass on an obstetric ultrasound study. The tumors were singular in 10 patients and multiple in 9. Tumor size ranged from 0.4 x 0.4 to 3.5 x 4 cm, and the majority of tumors were not hemodynamically significant. There were 17 patients with rhabdomyomas, 1 with a fibroma and 1 with an atrial hemangioma. Tuberous sclerosis complex was diagnosed in 10 patients. Partial or complete tumor regression was seen in eight patients; tumors were unchanged in five; and three required operation. CONCLUSIONS. Fetal cardiac tumors, a rare condition, are often benign. The majority of tumors are rhabdomyomas, but not all fetuses with rhabdomyoma have tuberous sclerosis.

This article has been cited by other articles:

				A. Motto, P. Ballo, A. Bocelli, S. Gramenzi, and M. de Martino Echocardiographic History of an Asymptomatic Congenital Cardiac Tumor: No Changes in Mass Dimensions During a 14-Year Follow-Up Circulation, November 21, 2006; 114(21): e591 - e593. [Full Text] [PDF]

				C. M. Ikemba, B. W. Eidem, V. V. Dimas, M. P. O'Day, and C. D. Fraser Jr Fetal Rhabdomyoma Causing Postnatal Critical Left Ventricular Outflow Tract Obstruction Ann. Thorac. Surg., October 1, 2005; 80(4): 1529 - 1529. [Full Text] [PDF]

				K. L. Gandy, M. A. Burtelow, V. M. Reddy, and N. H. Silverman Myofibroblastic tumor of the heart: A rare intracardiac tumor J. Thorac. Cardiovasc. Surg., September 1, 2005; 130(3): 888 - 889. [Full Text] [PDF]

				M. A. Padalino, C. Basso, O. Milanesi, V. L. Vida, G. S. Moreolo, G. Thiene, and G. Stellin Surgically treated primary cardiac tumors in early infancy and childhood J. Thorac. Cardiovasc. Surg., June 1, 2005; 129(6): 1358 - 1363. [Abstract] [Full Text] [PDF]

				I. M. Vettraino, N. J. Hoprasart, R. A. Bronsteen, and C. H. Comstock Clinical Implications of the Prenatal Sonographic Finding of Fetal Myocardial Echogenic Foci J. Ultrasound Med., February 1, 2005; 24(2): 195 - 199. [Abstract] [Full Text] [PDF]

				D. Paladini, A. Tartaglione, M. Vassallo, and P. Martinelli Prenatal Ultrasonographic Findings of a Cardiac Myxoma Obstet. Gynecol., November 1, 2003; 102(5): 1174 - 1176. [Abstract] [Full Text] [PDF]

				T. H. Kim, Y. M. Kim, M. Y. Han, W.-H. Kim, M.-H. Oh, and K. S. Han Perinatal Sonographic Diagnosis of Cardiac Fibroma with MR Imaging Correlation Am. J. Roentgenol., March 1, 2002; 178(3): 727 - 729. [Full Text] [PDF]

				R. J. Park and P. F. Bolton Pervasive Developmental Disorder and Obstetric Complications in Children and Adolescents with Tuberous Sclerosis Autism, September 1, 2001; 5(3): 237 - 248. [Abstract] [PDF]

				Y. Tomizawa, M. Endo, H. Nishida, C. Kikuchi, and H. Koyanagi Reconstruction of the left ventricle in a patient with cardiac hemangioma at the apex Ann. Thorac. Surg., June 1, 2001; 71(6): 2032 - 2034. [Abstract] [Full Text] [PDF]

				G R Veldtman, M E C Blackburn, G A Wharton, P daCosta, and J L Gibbs Dystrophic calcification of the fetal myocardium Heart, January 1, 1999; 81(1): 92 - 93. [Abstract] [Full Text]

				M. D. Cheitlin, J. S. Alpert, W. F. Armstrong, G. P. Aurigemma, G. A. Beller, F. Z. Bierman, T. W. Davidson, J. L. Davis, P. S. Douglas, L. D. Gillam, et al. ACC/AHA Guidelines for the Clinical Application of Echocardiography : A Report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines (Committee on Clinical Application of Echocardiography) Developed in Collaboration With the American Society of Echocardiography Circulation, March 18, 1997; 95(6): 1686 - 1744. [Full Text]