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Considerations for Prenatal Counselling of Patients with Cardiac Rhabdomyomas based on their Cardiac and Neurologic Outcomes

Published online by Cambridge University Press:  22 January 2010

Sabrina C. Degueldre
Affiliation:
Department of OBGYN and Divisions of Pediatric Cardiology and Neurology, University Hospital of Lausanne, Switzerland
Priya Chockalingam
Affiliation:
Department of OBGYN and Divisions of Pediatric Cardiology and Neurology, University Hospital of Lausanne, Switzerland
Yvan Mivelaz
Affiliation:
Department of OBGYN and Divisions of Pediatric Cardiology and Neurology, University Hospital of Lausanne, Switzerland
Stefano Di Bernardo
Affiliation:
Department of OBGYN and Divisions of Pediatric Cardiology and Neurology, University Hospital of Lausanne, Switzerland
Jean-Pierre Pfammatter
Affiliation:
Division of Pediatric Cardiology, University Hospital of Bern, Switzerland
Catherine Barrea
Affiliation:
Divison of Pediatric Cardiology, University Hospital of Saint-Luc, Bruxelles, Belgium
Nicole Sekarski
Affiliation:
Department of OBGYN and Divisions of Pediatric Cardiology and Neurology, University Hospital of Lausanne, Switzerland
Pierre-Yves Jeannet
Affiliation:
Department of OBGYN and Divisions of Pediatric Cardiology and Neurology, University Hospital of Lausanne, Switzerland
Jean-Claude Fouron
Affiliation:
Division of Pediatric Cardiology, Centre Hospitalier Universitaire de Sainte-Justine, Montreal, Canada
Yvan Vial
Affiliation:
Department of OBGYN and Divisions of Pediatric Cardiology and Neurology, University Hospital of Lausanne, Switzerland
Erik J. Meijboom*
Affiliation:
Department of OBGYN and Divisions of Pediatric Cardiology and Neurology, University Hospital of Lausanne, Switzerland
*
Correspondence to: Erik J. Meijboom, MD, PhD, FACC, Division Pediatric Cardiology, Centre Hospitalier Universitaire Vaudois (CHUV), BH 11, 626, Rue du Bugnon 46, 1011, Lausanne, Switzerland. Tel: +41 21 314 3553; Fax: +41 21 314 3665; E-mail: erik.meijboom@chuv.ch

Abstract

Cardiac rhabdomyomas are benign cardiac tumours with few cardiac complications, but with a known association to tuberous sclerosis that affects the neurologic outcome of the patients. We have analysed the long-term cardiac and neurological outcomes of patients with cardiac rhabdomyomas in order to allow comprehensive prenatal counselling, basing our findings on the records of all patients seen prenatally and postnatally with an echocardiographic diagnosis of cardiac rhabdomyoma encountered from August, 1982, to September, 2007. We analysed factors such as the number and the location of the tumours to establish their association with a diagnosis of tuberous sclerosis, predicting the cardiac and neurologic outcomes for the patients.

Cardiac complications include arrhythmias, obstruction of the ventricular outflow tracts, and secondary cardiogenic shock. Arrhythmias were encountered most often during the neonatal period, with supraventricular tachycardia being the commonest rhythm disturbance identified. No specific dimension or location of the cardiac rhabdomyomas predicted the disturbances of rhythm.

The importance of the diagnosis of tuberous sclerosis is exemplified by the neurodevelopmental complications, with four-fifths of the patients showing epilepsy, and two-thirds having delayed development. The presence of multiple cardiac tumours suggested a higher risk of being affected by tuberous sclerosis. The tumours generally regress after birth, and cardiac-related problems are rare after the perinatal period. Tuberous sclerosis and the associated neurodevelopmental complications dominate the clinical picture, and should form an important aspect of the prenatal counselling of parents.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2010

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