Sacrococcygeal Teratomas: Prenatal Surveillance, Growth and Pregnancy Outcome

Wilson, R. Douglas; Hedrick, Holly L.; Flake, Alan W.; Johnson, Mark P.; Bebbington, Michael; Mann, Sanjeet; Rychik, Jack; Liechty, Kenneth W.; Adzick, N. Scott

doi:10.1159/000188056

Cited by 93 publications

(70 citation statements)

References 25 publications

(16 reference statements)

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“…181 Assessment of the cardiovascular impact of sacrococcygeal teratomas and determination of prognosis can be performed with serial evaluation of heart size and cardiac output measures via Doppler interrogation of left and right outflow tracts. 524,525 Doppler interrogation of umbilical arterial flow with the finding of diminished or reversed diastolic flow reflecting competitive "steal" from the placenta to the sacrococcygeal teratoma is a marker for poor outcome. 526 Surgical resection and debulking of giant sacrococcygeal teratomas through open fetal surgery or embolization of feeder vasculature through laparoscopic techniques can improve survival.…”

Section: Sacrococcygeal Teratomasmentioning

confidence: 99%

Diagnosis and Treatment of Fetal Cardiac Disease

Donofrio¹,

Moon-Grady²,

Hornberger³

et al. 2014

Circulation

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914

487

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Background— The goal of this statement is to review available literature and to put forth a scientific statement on the current practice of fetal cardiac medicine, including the diagnosis and management of fetal cardiovascular disease. Methods and Results— A writing group appointed by the American Heart Association reviewed the available literature pertaining to topics relevant to fetal cardiac medicine, including the diagnosis of congenital heart disease and arrhythmias, assessment of cardiac function and the cardiovascular system, and available treatment options. The American College of Cardiology/American Heart Association classification of recommendations and level of evidence for practice guidelines were applied to the current practice of fetal cardiac medicine. Recommendations relating to the specifics of fetal diagnosis, including the timing of referral for study, indications for referral, and experience suggested for performance and interpretation of studies, are presented. The components of a fetal echocardiogram are described in detail, including descriptions of the assessment of cardiac anatomy, cardiac function, and rhythm. Complementary modalities for fetal cardiac assessment are reviewed, including the use of advanced ultrasound techniques, fetal magnetic resonance imaging, and fetal magnetocardiography and electrocardiography for rhythm assessment. Models for parental counseling and a discussion of parental stress and depression assessments are reviewed. Available fetal therapies, including medical management for arrhythmias or heart failure and closed or open intervention for diseases affecting the cardiovascular system such as twin–twin transfusion syndrome, lung masses, and vascular tumors, are highlighted. Catheter-based intervention strategies to prevent the progression of disease in utero are also discussed. Recommendations for delivery planning strategies for fetuses with congenital heart disease including models based on classification of disease severity and delivery room treatment will be highlighted. Outcome assessment is reviewed to show the benefit of prenatal diagnosis and management as they affect outcome for babies with congenital heart disease. Conclusions— Fetal cardiac medicine has evolved considerably over the past 2 decades, predominantly in response to advances in imaging technology and innovations in therapies. The diagnosis of cardiac disease in the fetus is mostly made with ultrasound; however, new technologies, including 3- and 4-dimensional echocardiography, magnetic resonance imaging, and fetal electrocardiography and magnetocardiography, are available. Medical and interventional treatments for select diseases and strategies for delivery room care enable stabilization of high-risk fetuses and contribute to improved outcomes. This statement highlights what is currently known and recommended on the basis of evidence and experience in the rapidly advancing and highly specialized field of fetal cardiac care.

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Section: Sacrococcygeal Teratomasmentioning

confidence: 99%

Diagnosis and Treatment of Fetal Cardiac Disease

Donofrio¹,

Moon-Grady²,

Hornberger³

et al. 2014

Circulation

Self Cite

914

487

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“…Myocardial depressant effects of anesthesia, fetal stress and the potential for placental insufficiency or mechanical cord compression can lead to significant alterations in the intraoperative cardiovascular state that may impact the conduct of the surgery and affect long-term outcomes. In fetal surgery candidates with anomalies such as sacrococcygeal teratoma or congenital cystic adenomatoid malformation, cardiovascular impairment is part of the natural pathophysiology of the condition [6,7]. Acute intraoperative changes in hemodynamics during fetal surgery in these cases are therefore to be expected and can be quite dramatic [4].…”

Section: Introductionmentioning

confidence: 99%

The Role of Echocardiography in the Intraoperative Management of the Fetus Undergoing Myelomeningocele Repair

Rychik¹,

Cohen

Tran

et al. 2014

Fetal Diagn Ther

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Introduction: Fetal surgery for myelomeningocele (MMC) results in better outcomes compared to postnatal treatment. However, risks are present. We describe our experience with intraoperative fetal echocardiography during repair of MMC and report on the management of serious cardiovascular events. Material and Methods: The subjects included fetuses with intent to repair MMC from January 2011 to February 2014. The protocol involved continuous echocardiography in a looping, sequential manner of systolic function, heart rate and tricuspid and mitral valve regurgitation. Results: A total of 101 cases intended fetal MMC repair; 100 completed surgery. Intraoperative ventricular dysfunction was present in 60% (20 mild, 25 moderate, 15 severe). Heart rate <100 bpm was noted in 11 cases. Tricuspid valve regurgitation was present in 35% (26 mild, 7 moderate, 2 severe); mitral valve regurgitation was present in 19% (15 mild, 4 moderate). Serious cardiovascular events were experienced in 7 cases, which affected the conduct of surgery and/or outcome. In 4 of these, medications were given via the umbilical vein and external cardiac compressions were performed. Fetal echocardiography was used to gauge the efficacy of compressions and to guide resuscitation. Discussion: Cardiovascular compromise is common during fetal surgery for MMC. Intraoperative fetal echocardiography is recommended as a growing number of centers contemplate offering this form of novel, but potentially risky, therapy.

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“…Cardiac output assessment has been proposed as a prognostic evaluation tool in various congenital malformations such as twin reversed arterial perfusion (TRAP) and sacrococcygeal teratoma [21,22]. These observations were made with Doppler-based calculations.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Doppler-Based and Three-Dimensional Methods for Fetal Cardiac Output Measurement

DeKoninck

Steenhaut²,

Mieghem³

et al. 2012

Fetal Diagn Ther

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Objective: Fetal cardiac output is conventionally measured using two-dimensional (2D) and Doppler ultrasound (Doppler). New methods based on 3D measurements of ventricular size in systole and diastole have been proposed. Our aim was to validate these tools against the conventional Doppler-based methods. Methods: Fetal combined cardiac output was prospectively measured at 16, 20, and 24 weeks of gestation in 15 uncomplicated pregnancies using Doppler and three different 3D algorithms [virtual organ computer-aided analysis (VOCAL), sonographic automatic volume calculation (SonoAVC), and inversion mode]. We determined the inter- and intraobserver variability of the 3D techniques and assessed the correlation between Doppler and 3D. Results: The 3D techniques showed adequate inter- and intraobserver reproducibility (intraclass correlation coefficient 0.69–0.98), with the best reproducibility for SonoAVC and inversion mode. Bland-Altman analysis revealed low bias and relatively good correlations when comparing the 3D methods among each other, albeit with wide 95% confidence intervals. Doppler measurement of fetal weight-adjusted combined cardiac output (349.0 ml·min^–1·kg^–1) yielded significantly higher results than 3D CO measurements (177.2, 160.7, and 174.0 ml·min^–1·kg^–1 for VOCAL, SonoAVC, and inversion mode, respectively; p < 0.0001) and correlated poorly with the 3D methods. Conclusions: Although 3D volume-based cardiac output measurements are reproducible, results obtained with different methods are not interchangeable. SonoAVC and inversion have the highest intra- and interobserver reproducibility. Results of cardiac output measurement by 3D and Doppler cannot be interchanged.

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Sacrococcygeal Teratomas: Prenatal Surveillance, Growth and Pregnancy Outcome

Cited by 93 publications

References 25 publications

Diagnosis and Treatment of Fetal Cardiac Disease

Diagnosis and Treatment of Fetal Cardiac Disease

The Role of Echocardiography in the Intraoperative Management of the Fetus Undergoing Myelomeningocele Repair

Comparison of Doppler-Based and Three-Dimensional Methods for Fetal Cardiac Output Measurement

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