Chan Y F, Sampson A
Department of Anatomical Pathology, Royal Women's Hospital, Melbourne, Australia.
Ultrasound Obstet Gynecol. 2005 Feb;25(2):193-6. doi: 10.1002/uog.1812.
Massive myocardial calcifications were detected by antenatal ultrasound examination in four second-trimester fetuses. In one fetus, multiple cardiac rhabdomyomas were the initial diagnosis. One fetus presented with arthrogryposis and the brain and spinal cord showed severe hypoxic-ischemic damage. One fetus was hydropic and had severe cardiac malformations. The fourth fetus had congenital heart block and maternal serum was positive for anti-Ro and anti-La antibodies. Myocardial calcifications in the first three fetuses were most likely to be caused by hypoxic-ischemic damage to the heart, and immunological mechanisms were responsible in the other fetus. Antenatally detected myocardial echogenic foci in a fetus leading to a termination of pregnancy or associated with fetal death should be investigated with a full postmortem examination. It is important to confirm the presence of calcifications as distinct from a rhabdomyoma as genetic counseling is completely different. The demonstration of associated lesions in other organs also helps to explain the pathogenesis underlying this condition.
在孕中期的4例胎儿中，产前超声检查发现了大量心肌钙化。其中1例胎儿最初诊断为多发性心脏横纹肌瘤。1例胎儿表现为关节挛缩，脑和脊髓显示严重的缺氧缺血性损伤。1例胎儿出现水肿并伴有严重心脏畸形。第4例胎儿患有先天性心脏传导阻滞，母亲血清抗Ro和抗La抗体呈阳性。前3例胎儿的心肌钙化很可能是由心脏缺氧缺血性损伤引起的，而另一例胎儿则是由免疫机制导致的。对于产前检测到胎儿心肌回声灶并导致终止妊娠或与胎儿死亡相关的情况，应进行全面的尸检调查。确认钙化的存在与横纹肌瘤不同很重要，因为遗传咨询完全不同。其他器官相关病变的证实也有助于解释这种情况的发病机制。
