Fetal cardiac tumours in a referral prenatal cardiology centre – series of 37 cases with neonatal follow-up

Abstract

Introduction: Fetal cardiac tumours are relatively rare findings. The aim of this research was to present the natural course in a series of 37 fetuses with cardiac tumours, who had fetal echocardiography performed and the pregnancies had been continued until term. Material and methods: This was a retrospective analysis of 37 cases with prenatally detected heart tumour. The study group was divided into multiple-and single-tumour subgroups and into survivors versus non-survivors. The number of survivors in subgroups and the incidence of prognostic factors were compared by c 2 test. The presence of additional cardiac anomalies, the way of delivery and neonatal follow-up was analysed. The literature (Pub Med) was reviewed. Results: There was no statistical difference between the number of survivors in groups of single versus multiple tumours (p > 0.05). In group of non-survivors there was a higher incidence of bad prognostic factors detected prenatally: pericardial effusion, mitral regurgitation, and cardiomegaly (p < 0.05). The authors suggested a different way of perinatal care and counselling in multiple and single fetal heart tumours. Conclusions: Fetal cardiac tumours in the majority of cases were rhabdomyoma, and in case of normal heart anatomy and normal intracardiac flow the short-term prognosis was good. Fetal single heart tumour with progression of its size in the third trimester may require early surgical resection, so delivery in a tertiary perinatal and cardiac surgery centre might be necessary. Pericardial effusion, mitral regurgitation, and cardiomegaly might implicate a worse prognosis in the case of fetal heart tumour. Fetal cardiac tumour may require a multispecialist team approach to benefit from early detection and diagnosis.

Massive fetal cardiac rhabdomyoma treated with transplacental sirolimus

“…However, maternal use of mTORi therapy is also thought to increase risk of fetal growth restriction due to effects on transfer of substrates including fatty acids, glucose, and amino acids, and possible resulting placental insufficiency [6]. As mentioned in one large case series investigating prognostic factors relating to fetal cardiac tumors, use of mTORi therapy is still isolated and has an unknown safety profile [7]. Transplant Pregnancy Registry International data through 2020 does provide reassuring support that sirolimus exposure during all stages of pregnancy does not appear to correlate with congenital fetal anomalies [8].…”