Clinical value of prenatal echocardiographic examination in the diagnosis of fetal cardiac tumors

Abstract

The aim of the present study was to explore the clinical value of prenatal echocardiographic examination in the diagnosis of fetal cardiac tumors. In total, the cases of 8 fetuses with fetal cardiac tumors, which were identified by prenatal ultrasound examination in The First Affiliated Hospital of Nanchang University between January 2012 and January 2014, were retrospectively analyzed. The size, shape, location, activity and hemodynamic changes of the lesions were described in detail, and the patients were followed up. Out of the 8 identified cases of fetal cardiac tumors, 2 fetuses contained tumors only in the left ventricular cavity and 6 fetuses contained tumors of the left and right ventricular cavities, interventricular septum and apex of the heart. Overall, 5 of the 8 female patients requested termination of the pregnancy and labor was induced. The fetuses were pathologically confirmed to possess rhabdomyoma. In addition, 1 patient was followed-up for 5 weeks, and the tumor in the fetal heart cavity was found to have enlarged and developed in multiple regions when follow-up was performed. The patient then requested termination of the pregnancy and labor was induced. The fetus was pathologically confirmed to possess rhabdomyoma. The remaining 2 patients insisted on continuation of the pregnancy and the fetuses were followed up during gestation and subsequent to birth by echocardiographic examination. Prenatal echocardiography may precisely position and diagnose occupying lesions of the fetal heart, which is of considerable value in clinical decision making and instruction for treatment.

Keywords: fetal heart; occupying lesions; prenatal echocardiographic examination; rhabdomyoma.

Figure 1.

Fetal echocardiography of a pregnant woman at 34 weeks gestation revealing multiple tumors located in the RV and ventricular wall of the fetal heart. The patient chose to continue the pregnancy and during follow-up the cardiac tumors were confirmed by echocardiography. (A) Fetal echocardiography performed on a pregnant woman at 34 weeks gestation, revealing multiple occupying masses located in the ventricular wall and chambers of the fetal heart. (B) Echocardiography performed on the 1-day-old neonate using a superficial probe detected the occupying masses in the RV cavity and interventricular septum. M, masses; LV, left ventricle; LA, left atrium; RV, right ventricle; RA, right atrium; AO, aorta; LVOT, left ventricular outflow tract; IVS, interventricular septum.

Figure 2.

Fetal electrocardiography performed on a pregnant woman at 21 weeks gestation revealed a single tumor located in the LV of the fetal heart. After 5 weeks, the patient was followed up and it was found that the hyperechoic mass in the left ventricular cavity of the fetal heart had increased, and another hyperechoic mass was found in the right ventricular cavity. The patient then chose to terminate the pregnancy. Autopsy examination confirmed that the masses were rhabdomyoma. (A) Fetal electrocardiography performed on a pregnant woman at 21 weeks gestation revealed a single tumor located in the LV of the fetal heart. (B) Fetal electrocardiography performed on a pregnant woman at 26 weeks gestation revealed two masses located in the LV and RV of the fetal heart. (C) Anatomic image of the fetal heart captured subsequent to autopsy. (D) Microscopic histological observation of rhabdomyoma revealing that the cells were vacuolated in unequal sizes and the nuclei were located in the center of the cells, with a small amount of surrounding cytoplasm in a spider-like radial distribution (arrow). Stain, hematoxylin and eosin; magnification, ×400. M, masses; LV, left ventricle; RV, right ventricle; LA, left atrium; RA, right atrium; DAO, descending aorta; SP, spinal.