Cardiac hemangioma during fetal life


The prevalence of cardiac tumors has been reported to be 0.05% in an autopsy study of infants only. Cardiac hemangioma in infancy is extremely rare and resection of these tumors after prenatal diagnosis has been rarely reported. There have been approximately 40 reported cases of primary cardiac hemangiomas in current cardiac literature. McAllister reviewed 533 primary tumors and cysts of the heart and pericardium of which 15 (2.8%) were hemangiomas. Two types of cardiac hemangiomas consist of closely packed capillary structures (capillary type) or widely dilated
vascular channels (cavernous type) with focal connective tissue in the walls. They are lined by endothelial cells and mitosis is rare. This tumor can be localized in any part of the heart and pericardium. Hemangiomas can present in any age group with a mild predominance in females. The symptomatology depends on the anatomic location and extension of the tumor. Though most cardiac hemangiomas are discovered incidentally, they may cause dyspnea, palpitation, atypical chest pain and arrhythmia. Some of these tumors may also cause a pericardial effusion.

Echocardiography is usually the initial imaging modality. During prenatal echo screening may be detected a supraventricular tachycardia in association with mild tricuspid regurgitation or pericardial effusion and this led to a fetal echocardiography. The echocardiographic appearance of the tumor is complex with multiple cystic spaces and must be differentiate from a teratoma The increase in the size of the pericardial effusion to over possible cardiac tamponade.
There has been a reported case of spontaneous resolution of a cardiac hemangioma, but this is more typical of cardiac rhabdomyomas where upto 70% of tumors can regress spontaneously. The natural history of cardiac hemangiomas is variable and is the reason why all resectable lesions must be surgically removed. The long-term prognosis is favorable after adequate surgical resection. Unresectable tumors have a poor prognosis and may lead to sudden death due to arrhythmias. Non-surgical management of complicated hemangiomas has been described.

References

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– Eckstein FS, Heinemann MK,Mielke GJ, Greschniok A, Bader, Ziemer G. Resection of a large right atrial hemangioma in a neonate after prenatal diagnosis. Ann Thorac Surg 1999; 68:1074-1075.

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– Chang E, Boyd A, Nelson CC. Successful treatment of infantile hemangiomas with interferon-alpha-2b. J Pediatr Hematol Oncol 1997;19:237-244.

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