Geipel A, Krapp M, Germer U, Becker R, Gembruch U
Division of Prenatal Medicine, Department of Obstetrics and Gynecology, Medical University of Lübeck, Ratzeburger Allee 233, D-23538 Lübeck, Germany.
Ultrasound Obstet Gynecol. 2001 Jan;17(1):17-21. doi: 10.1046/j.1469-0705.2001.00314.x.
As fetal cardiac tumors are a rare condition, we report the perinatal diagnosis and ultrasound findings of 12 cases.
In 10 cases the tumors were identified prenatally by fetal echocardiography; gestational age at detection ranged from 22 to 34 weeks. In two symptomatic infants cardiac tumors were diagnosed on the first day postpartum; prenatal ultrasound evaluation at 26 and 38 weeks of gestation did not reveal a cardiac lesion.
Six fetuses had singular tumors, in six fetuses they were multifocal. The left ventricle was most often affected. Termination of pregnancy was chosen in three cases, one in association with trisomy 21 and tuberous sclerosis. One intrauterine and three neonatal deaths due to cardiac failure occurred. Histopathologic examination revealed cardiac rhabdomyoma in six fetuses and fibroma in one case. In the five surviving fetuses the size of the tumors spontaneously decreased postpartum. Rhabdomyomata were associated with tuberous sclerosis in four out of 11 cases.
Cardiac tumors are detectable as early as 22 weeks of gestation. Presenting symptoms may be arrhythmia, dysfunction of the atrioventricular valves, pericardial effusion and fetal hydrops. The most common perinatal diagnosis is rhabdomyoma, which is often associated with tuberous sclerosis. Sequential examination in high risk patients should be considered as most tumors increase in size during pregnancy and may become evident in late second and third trimester of pregnancy. Postpartum, however, regression of tumor size is common.
由于胎儿心脏肿瘤是一种罕见疾病，我们报告12例围产期诊断及超声检查结果。
10例胎儿肿瘤通过胎儿超声心动图在产前确诊；发现时的孕周为22至34周。2例有症状的婴儿在产后第一天被诊断出心脏肿瘤；妊娠26周和38周时的产前超声检查未发现心脏病变。
6例胎儿为单发肿瘤，6例为多发肿瘤。最常受累的是左心室。3例选择终止妊娠，1例合并21三体综合征和结节性硬化症。发生1例宫内死亡和3例因心力衰竭导致的新生儿死亡。组织病理学检查显示6例胎儿为心脏横纹肌瘤，1例为纤维瘤。5例存活胎儿的肿瘤大小在产后自发缩小。11例中有4例横纹肌瘤与结节性硬化症有关。
心脏肿瘤早在妊娠22周时即可被检测到。出现的症状可能有心律失常、房室瓣功能障碍、心包积液和胎儿水肿。最常见的围产期诊断是横纹肌瘤，常与结节性硬化症有关。高危患者应考虑进行连续检查，因为大多数肿瘤在孕期会增大，可能在妊娠晚期的第二和第三个月变得明显。然而，产后肿瘤大小缩小很常见。
