intracardiac tumor

8/7/2019 Intracardiac tumor

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NNEONATAL CARDIAC TUMOREONATAL CARDIAC TUMOR

-- CASE REPORTCASE REPORT

*Coleta Elena, *Siminel Mirela, *Gheonea Mihaela*Coleta Elena, *Siminel Mirela, *Gheonea Mihaela,,

** Bataiosu** Bataiosu Constantin, **Istratoaie OctavianConstantin, **Istratoaie Octavian

**Neonatology and **Cardiology Department

University of Medecine and Pharmacy of Craiova


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Heart tumors are uncommon in fetusHeart tumors are uncommon in fetus

and neonateand neonate

According to different studies the incidence is:According to different studies the incidence is:

0.14%0.14% /14000 fetal echo/14000 fetal echo (Holley et. all. J.(Holley et. all. J.Am. Coll. Cardiology 1995, an eight yearAm. Coll. Cardiology 1995, an eight year

revue).revue).

0.17%0.17% /5276 fetal echo ( Pipitone S./5276 fetal echo ( Pipitone S.Ital.Heart J. 2002)Ital.Heart J. 2002)


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Most common benigne tumor is:Most common benigne tumor is:

rhabdomyoma( 60%) followed byrhabdomyoma( 60%) followed by

teratoma,teratoma,

vascular tumor,vascular tumor,

fibromafibroma

and myxoma.and myxoma.

There is a strong associations betweenThere is a strong associations between

tuberous sclerosis and rhabdomyoma.tuberous sclerosis and rhabdomyoma.

Some tumors can regress spontaneously.Some tumors can regress spontaneously.


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Presenting clinical signs varies from:Presenting clinical signs varies from:

murmur

arrhythmia respiratory distress

cardiac failure


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In a retrospective analysis of medical recordsIn a retrospective analysis of medical records

of a primary cardiac tumors between 1977of a primary cardiac tumors between 1977--

2007, from a total of2007, from a total of27 tumors27 tumors,, 11 cases11 cases

diagnosis beginning with a discovery of adiagnosis beginning with a discovery of a

heart murmur, and most of them were in theheart murmur, and most of them were in theleft ventricle.left ventricle.

Sanchez et all. An. Paediatr. Barc. 2008Sanchez et all. An. Paediatr. Barc. 2008


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In a study evaluating cardiac tumors andIn a study evaluating cardiac tumors andsurgical treatment over 20 years periodsurgical treatment over 20 years period

from a total offrom a total of 12patients12patients,, 22new bornsnew borns

with left ventricular tumor developedwith left ventricular tumor developed

univentricular physiology acting likeuniventricular physiology acting like

hypoplastic left sindrom at birth.hypoplastic left sindrom at birth.

ElderkinR., Radford DJ, J. Paediatr. HealthElderkinR., Radford DJ, J. Paediatr. Health


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Imaging techniques such as 2Imaging techniques such as 2

dimensional echocardiographydimensional echocardiography

contribute to early diagnosis,contribute to early diagnosis,

treatment and improved survivaltreatment and improved survival..


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CASE REPORTCASE REPORT

An apparent healthyAn apparent healthy bbaby girl GA=37 weeks,aby girl GA=37 weeks, BW=2630g; L=47cm;CP=32cm;TP=31cmBW=2630g; L=47cm;CP=32cm;TP=31cm

born by vaginal delivery, the baby did notborn by vaginal delivery, the baby did not

require resuscitation, Apgar score were 8/9.require resuscitation, Apgar score were 8/9.

Postnatal adaptation was good!Postnatal adaptation was good!

Family history unremarkableFamily history unremarkable

Mother healthy IIG, II P, pregnancy courseMother healthy IIG, II P, pregnancy coursenormal, monthly controls, no ultrasoundnormal, monthly controls, no ultrasound

examinations.examinations.


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In the third day of life the baby presents aIn the third day of life the baby presents a

mild cardiac systolic murmurmild cardiac systolic murmur22/6/6

in the leftin the leftparasternal region.parasternal region.

EKGEKG Sinus tachycardiaSinus tachycardia

Oxygen saturation was normal, bloodOxygen saturation was normal, bloodpressure values in all four limbs wherepressure values in all four limbs wherenormal with no discrepancy betweennormal with no discrepancy between

upper and lower limbs.upper and lower limbs.

The rest of systemic examination wasThe rest of systemic examination wasalso normal.also normal.


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Chest Xray:Chest Xray:

Normal pulmonaryNormal pulmonary

transparency.transparency. Cardiac silhouetteCardiac silhouette

Cti=0,60.Cti=0,60.


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Serial 2D Doppler echocardiographySerial 2D Doppler echocardiography

revealed:revealed:

a largea large left ventricular tumorleft ventricular tumoroccupyingoccupying

2/3 of LV without obstruction of outflow2/3 of LV without obstruction of outflow

tract.tract.

foramen ovale with bidirectional shuntforamen ovale with bidirectional shunt

LV, RV outflow tract with no obstruction.LV, RV outflow tract with no obstruction.


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long axislong axis


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long axislong axis


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apical 4 chambersapical 4 chambers


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apical4 C do

pplercolor

apical4 C do

pplercolor


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apical 4 C dopplercolor2apical 4 C dopplercolor2


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Laboratory investigations: normal bloodLaboratory investigations: normal blood

count and biochemical values.count and biochemical values.

The infant had a good clinical course, noThe infant had a good clinical course, no

hemodynamic disturbances, was bottlehemodynamic disturbances, was bottle

fed, gaining weight.fed, gaining weight. On subsequent echocardiographicOn subsequent echocardiographic

examinations tumor size remainexaminations tumor size remain

unchanged and baby was referred to aunchanged and baby was referred to atertiary pediatric cardiology center fortertiary pediatric cardiology center for

further evaluation.further evaluation.


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ConclusionsConclusions

In the presence of a cardiac murmur or anIn the presence of a cardiac murmur or anenlarged heart in a new born we shouldenlarged heart in a new born we shouldhave in mind not only a congenital hearthave in mind not only a congenital heartdisease.disease.

In our patient the clinical presentationIn our patient the clinical presentationwaswas thethe murmurmurmurappearedappeared in the third dayin the third dayof life.of life.

Despite of the location and the size ofDespite of the location and the size oftumor our patient did not developedtumor our patient did not developedsymptoms of hemodynamic compromisesymptoms of hemodynamic compromiseduring the first month of life.during the first month of life.


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the absence of any cardiac failure signsthe absence of any cardiac failure signsuntil she suddenly died probably due to auntil she suddenly died probably due to a

ventricle arrhythmia at 6 weeks of life.ventricle arrhythmia at 6 weeks of life.

The particularity of the case:The particularity of the case:


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At 1 month of lifeAt 1 month of life

intracardiac tumor

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