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Diagnosis and management of fetal cardiac tumors: A multicenter experience and review of published reports
CONGENITAL/FETAL
CARDIOLOGY
characterization of anterograde accessory connection conduction properties. Results: Tachycardia mechanisms were concordant in 56 of 57 patients: orthodromic reciprocating tachycardia in 43, antidromic reciprocating tachycardia in 1, both orthodromic and antidromic tachycardia in 2, AV node reentrant tachycardia in 5, atria1 reentrant tachycardia in 4 and ectopic atria1 tachycardia in 2. Of 29 patients with orthodromic reciprocating tachycardia using a concealed accessory connection, transesophageal study predicted the accessory connection site through changes induced by transient bundle branch block in 12. By the Bland-Altman method in 14 patients with pre-excitation, the anterograde accessory connection effective refractory period determined by transesophageal study compared favorably with that determined by intracardiac study (mean difference 5.0 ms, limits of agreement -55 and 65 ms). Conclusions: Transesophageal electrophysiologic studies are a highly accurate means of diagnosing and characterizing various mechanisms of supraventricular tachycardia in pediatric patients.
One with tetralogy of Fallot died after reoperation, the other with persistent truncus arteriosus due to sepsis. When the echocardiographic findings are in full agreement with the clinical status, physical examination, ECG and chest X-ray, we recommend cardiac surgery without prior catheterization in many patients with CHD. Diagnosis and Management of Fetal Cardiac Tumors: A Multicenter Experience and Review of Published Reports D.G. Holley, G.K. Martin, ].l. Brenner, DA Fyfe, J.C. Huhta, CL Kleinman, LB. Ritter, NH. Silverman. I I I Michigan Avenue, NW, Washington, D.C. ] Am Coil Cardiol 1995;26:516-20.
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 atria1 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.
Seven-Year Experience of Noninvasive Preoperative Diagnostics in Children With Congenital Heart Defects: Comprehensive Analysis of 2,788 Consecutive Patients J. Mar&, j. Skovranek, B. Hucin, V. Chaloupecky, P. Tax, 0. Reich, M. Samanek. Kardiocentrum, University Hospiil Motel, Prague, Czechoslovakia. Cardiology I995;86: 488-95.
The spectrum of patients operated on without preoperative catheterization and angiography, the accuracy of echocardiographic diagnosis and its impact on the results of surgical treatment were prospectively assessed in 2,788 children consecutively operated for congenital heart defects (CHD) between 1986 and 1992. The overall percentage of surgery based solely on noninvasive preoperative examination increased from 63% in 1986 to 81% in 1990 and decreased to 72% in 1992. There were no differences in the preoperative diagnostic approach between groups of newborn, infants and children. A high percentage of patients with patent ductus arteriosus (96.5%), atria1 septal defect (94%), incomplete atrioventricular septal defect (88.6%), ventricular septal defect (86.3%), coarctation of the aorta (80.2%) and total anomalous pulmonary venous connection (79.3%) was referred for surgery without prior invasive examination, while a lower percentage was found in univentricular heart (48.4%), pulmonary atresia (34.6%) and double outlet right ventricle (27.7%). More patients with pulmonary and tricuspid atresia were catheterized before complete repair compared to those who underwent palliative surgery (p CO.01 and p
Assessment of Fetal Compromise by Doppler Ultrasound Investigation of the Fetal Circulation: Arterial, Intracardiac, and Venous Blood Flow Velocity Studies Kurt Hecher, Stuart Campbell, Pat Doyle, Kevin Harrington, Kypror Nicolaides. Department of Obrtetrio; and Gynaecology, King’s College School of Medicine and Dentistry, Denmark Hill, London; Department of Epidemiology and Population Sciences, London School of Hygiene and Tropical Medicine, Univerriv of London, London, Great Britain. Circulation I995;9 I: 129-38.
Background: Doppler studies of the fetal circulation in intrauterine growth retardation and hypoxia have demonstrated
ACCCURRE\JTJOURNALREVIEW
40
~ar~hlhpd
1996
CARDIOLOGY
characterization of anterograde accessory connection conduction properties. Results: Tachycardia mechanisms were concordant in 56 of 57 patients: orthodromic reciprocating tachycardia in 43, antidromic reciprocating tachycardia in 1, both orthodromic and antidromic tachycardia in 2, AV node reentrant tachycardia in 5, atria1 reentrant tachycardia in 4 and ectopic atria1 tachycardia in 2. Of 29 patients with orthodromic reciprocating tachycardia using a concealed accessory connection, transesophageal study predicted the accessory connection site through changes induced by transient bundle branch block in 12. By the Bland-Altman method in 14 patients with pre-excitation, the anterograde accessory connection effective refractory period determined by transesophageal study compared favorably with that determined by intracardiac study (mean difference 5.0 ms, limits of agreement -55 and 65 ms). Conclusions: Transesophageal electrophysiologic studies are a highly accurate means of diagnosing and characterizing various mechanisms of supraventricular tachycardia in pediatric patients.
One with tetralogy of Fallot died after reoperation, the other with persistent truncus arteriosus due to sepsis. When the echocardiographic findings are in full agreement with the clinical status, physical examination, ECG and chest X-ray, we recommend cardiac surgery without prior catheterization in many patients with CHD. Diagnosis and Management of Fetal Cardiac Tumors: A Multicenter Experience and Review of Published Reports D.G. Holley, G.K. Martin, ].l. Brenner, DA Fyfe, J.C. Huhta, CL Kleinman, LB. Ritter, NH. Silverman. I I I Michigan Avenue, NW, Washington, D.C. ] Am Coil Cardiol 1995;26:516-20.
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 atria1 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.
Seven-Year Experience of Noninvasive Preoperative Diagnostics in Children With Congenital Heart Defects: Comprehensive Analysis of 2,788 Consecutive Patients J. Mar&, j. Skovranek, B. Hucin, V. Chaloupecky, P. Tax, 0. Reich, M. Samanek. Kardiocentrum, University Hospiil Motel, Prague, Czechoslovakia. Cardiology I995;86: 488-95.
The spectrum of patients operated on without preoperative catheterization and angiography, the accuracy of echocardiographic diagnosis and its impact on the results of surgical treatment were prospectively assessed in 2,788 children consecutively operated for congenital heart defects (CHD) between 1986 and 1992. The overall percentage of surgery based solely on noninvasive preoperative examination increased from 63% in 1986 to 81% in 1990 and decreased to 72% in 1992. There were no differences in the preoperative diagnostic approach between groups of newborn, infants and children. A high percentage of patients with patent ductus arteriosus (96.5%), atria1 septal defect (94%), incomplete atrioventricular septal defect (88.6%), ventricular septal defect (86.3%), coarctation of the aorta (80.2%) and total anomalous pulmonary venous connection (79.3%) was referred for surgery without prior invasive examination, while a lower percentage was found in univentricular heart (48.4%), pulmonary atresia (34.6%) and double outlet right ventricle (27.7%). More patients with pulmonary and tricuspid atresia were catheterized before complete repair compared to those who underwent palliative surgery (p CO.01 and p
Assessment of Fetal Compromise by Doppler Ultrasound Investigation of the Fetal Circulation: Arterial, Intracardiac, and Venous Blood Flow Velocity Studies Kurt Hecher, Stuart Campbell, Pat Doyle, Kevin Harrington, Kypror Nicolaides. Department of Obrtetrio; and Gynaecology, King’s College School of Medicine and Dentistry, Denmark Hill, London; Department of Epidemiology and Population Sciences, London School of Hygiene and Tropical Medicine, Univerriv of London, London, Great Britain. Circulation I995;9 I: 129-38.
Background: Doppler studies of the fetal circulation in intrauterine growth retardation and hypoxia have demonstrated
ACCCURRE\JTJOURNALREVIEW
40
~ar~hlhpd
1996