Cardiac diverticulum with pericardial effusion: report of two new cases treated by in-utero pericardiocentesis and a review of the literature

Abstract

Congenital cardiac diverticula are rare abnormalities that may occur as isolated malformations. They are often associated with pericardial effusions, which may cause both pulmonary hypoplasia and progressive fetal hydrops. Few cases are reported in fetal life. Mount Sinai Hospital, Toronto, has previously reported two cases of cardiac diverticula complicated with pericardial effusion successfully treated in utero with aspiration of the pericardial fluid. Here a further two cases of isolated apical right ventricular diverticula with large pericardial effusion, one diagnosed at 16 weeks and another at 13 weeks' gestation are described. In-utero drainage of pericardial effusion was performed once in each case at 16 and 14 weeks' gestation, respectively, with good neonatal outcome. Both had normal karyotype and there was no evidence of maternal or fetal infection. The pericardial effusion did not recur in either case. Given the otherwise favorable prognosis for this lesion, and the excellent response in these cases, prenatal pericardiocentesis should be considered in similar cases.