Schmidt K G, Silverman N H, Harison M R, Callen P W
Department of Pediatrics, University of California, San Francisco 94143.
J Pediatr. 1989 Jun;114(6):1023-8. doi: 10.1016/s0022-3476(89)80456-1.
With two-dimensional echocardiography and Doppler ultrasound, we demonstrated high-output cardiac failure in three fetuses with large sacrococcygeal teratomas. All fetuses had normal cardiac structure, dilated ventricles maintaining a normal fractional shortening index, a dilated inferior vena cava reflecting the increased venous return from the lower body, pericardial and pleural effusions as a manifestation of fetal hydrops, and a markedly thickened placenta. When fetal hydrops was present, the combined ventricular output was very high (mean 1280 ml/min/kg; normal 553 +/- 153 (SD)). Descending aortic flow was also sharply increased (mean 930 ml/min/kg; normal 184 +/- 20), as was placental flow (mean 480 ml/min/kg, normal 110 +/- 26). High-velocity arterial flow signals were also found within the tumor. In one fetus studied serially, placental thickness and tumor diameter increased rapidly; placental flow as a percentage of descending aortic flow decreased, indicating a further increase of flow to the tumor. These abnormal hemodynamic changes were reversed after the fetus's teratoma was surgically removed. We conclude that the sacrococcygeal teratoma acts as a large arteriovenous fistula, which causes high-output cardiac failure. Surgical removal of the teratoma in a previable fetus with such hemodynamic findings may prove to be the most effective treatment.
通过二维超声心动图和多普勒超声，我们在3例患有巨大骶尾部畸胎瘤的胎儿中证实了高输出量性心力衰竭。所有胎儿心脏结构正常，心室扩张但保持正常的缩短分数指数，下腔静脉扩张反映来自下半身的静脉回流增加，心包和胸腔积液作为胎儿水肿的表现，以及胎盘明显增厚。当出现胎儿水肿时，联合心室输出量非常高（平均1280 ml/min/kg；正常为553±153（标准差））。降主动脉血流也急剧增加（平均930 ml/min/kg；正常为184±20），胎盘血流亦是如此（平均480 ml/min/kg，正常为110±26）。在肿瘤内还发现了高速动脉血流信号。在1例进行连续研究的胎儿中，胎盘厚度和肿瘤直径迅速增加；胎盘血流占降主动脉血流的百分比下降，表明流向肿瘤的血流进一步增加。在胎儿的畸胎瘤手术切除后，这些异常的血流动力学变化得到了逆转。我们得出结论，骶尾部畸胎瘤起到了一个大动静脉瘘的作用，导致高输出量性心力衰竭。对于具有此类血流动力学表现的可存活前胎儿，手术切除畸胎瘤可能被证明是最有效的治疗方法。
