PDF herunterladen
Ultraschall Med 2011; 32(1): 26-32
DOI: 10.1055/s-0028-1110007
Übersicht/Review

© Georg Thieme Verlag KG Stuttgart · New York

Aneurysms of the Fetal Heart

Aneurysmen des fetalen HerzensJ. Weichert1 , R. Axt-Fliedner2 , 3
  • 1Ob/Gyn, Division of Prenatal Medicine, University of Schleswig-Holstein, Campus Luebeck
  • 2Division of Prenatal Medicine, University Gießen and Marburg
Weitere Informationen

Publikationsverlauf

received: 17.6.2009

accepted: 4.12.2009

Publikationsdatum:
20. April 2010 (online)

Auch verfügbar auf
    Lizenzen und Reprints

Zusammenfassung

Aneurysmatische Wandausstülpungen ventrikulärer/atrialer Strukturen oder der kardialen Auslassgefäße sind seltene fetale Anomalien. Die pränatale Diagnose wird in der Regel durch detaillierte echokardiografische Untersuchung des Fetalherzens gestellt. Bei der Mehrzahl dieser angeborenen Fehlbildungen handelt es sich um Störungen in der Embryonalentwicklung der Herzanlage und der abgehenden Gefäße. Die meisten betroffenen Feten zeigen einen unauffälligen Verlauf der Fetalperiode. Assoziierte Fehlbildungen betreffen sowohl kardiale als auch extrakardiale Malformationen mit potenziell Prognose bestimmendem Einfluss auf die vorgeburtliche, perinatale und frühkindliche Entwicklung. Die Therapieausrichtung sollte individuell angepasst werden und sich an der Ausprägung der klinischen Symptomatik orientieren.

Abstract

Aneurysmatic bulgings of either ventricular/atrial structures or outflow tract vessels such as the ductus arteriosus are rare prenatal conditions. Prenatal diagnosis is confirmed by detailed echocardiographic examination of the fetal heart. The majority of these congenital abnormalities are probably related to developmental disorders. Most of the affected fetuses display an asymptomatic course antenatally and postnatally. Associated anomalies include additional cardiac and extracardiac malformations with potential impact on normal development in fetal and neonatal life as well as early childhood. Treatment considerations have to be individually specified and depend on the presence and severity of clinical issues.

Key words

heart - echocardiography - ultrasound 2D - ultrasound Doppler - fetus

References

  • 1 Mayer K, Candinas R, Radounislis C. et al . Congenital left ventricular aneurysms and diverticula: clinical findings, diagnosis and course.  Schweiz Med Wochenschr. 1999;  129 1249-1256
    Google Scholar
  • 2 Wahl A, Meier B. Patent foramen ovale and ventricular septal defect closure.  Heart. 2009;  95 70-82
    Google Scholar
  • 3 Ghosh S, Ghosh A K, Ghosh S K. Patent foramen ovale and atrial septal aneurysm in cryptogenic stroke.  Postgrad Med J. 2007;  83 173-177
    Google Scholar
  • 4 Ohlow M A. Congenital left ventricular aneurysms and diverticula: definition, pathophysiology, clinical relevance and treatment.  Cardiology. 2006;  106 63-72
    Google Scholar
  • 5 Sherman S J, Leenhouts K H, Utter G O. et al . Prenatal diagnosis of left ventricular aneurysm in the late second trimester: a case report.  Ultrasound Obstet Gynecol. 1996;  7 456-457
    Google Scholar
  • 6 Hornberger L K. Congenital ductus arteriosus aneurysm.  J Am Coll Cardiol. 2002;  39 348-350
    Google Scholar
  • 7 Merz E, Welter C. 2D and 3D Ultrasound in the evaluation of normal and abnormal fetal anatomy in the second and third trimesters in a level III center.  Ultraschall in Med. 2005;  26 9-16
    Google Scholar
  • 8 Papagiannis J, Van Praagh R, Schwint O. et al . Congenital left ventricular aneurysm: clinical, imaging, pathologic, and surgical findings in seven new cases.  Am Heart J. 2001;  141 491-499
    Google Scholar
  • 9 Marijon E, Ou P, Fermont L. et al . Diagnosis and outcome in congenital ventricular diverticulum and aneurysm.  J Thorac Cardiovasc Surg. 2006;  131 433-437
    Google Scholar
  • 10 Stańczyk J, Moll J, Wilczyński J. Prenatal diagnosis of a fetal left atrial diverticulum.  Prenat Diagn. 1999;  19 1055-1057
    Google Scholar
  • 11 Moraes F, Santos C L, Lira V. et al . Congenital aneurysm of the right atrium.  Eur J Cardiothorac Surg. 2001;  19 943-944
    Google Scholar
  • 12 Hanley P C, Tajik A J, Hynes J K. et al . Diagnosis and classification of atrial septal aneurysm by two-dimensional echocardiography: report of 80 consecutive cases.  J Am Coll Cardiol. 1985;  6 1370-1382
    Google Scholar
  • 13 Rice M J, McDonald R W, Reller M D. Fetal atrial septal aneurysm: a cause of fetal atrial arrhythmias.  J Am Coll Cardiol. 1988;  12 1292-1297
    Google Scholar
  • 14 Stewart P A, Wladimiroff J W. Fetal atrial arrhythmias associated with redundancy/aneurysm of the foramen ovale.  J Clin Ultrasound. 1988;  16 643-650
    Google Scholar
  • 15 Ozcelik N, Atalay S, Tutar E. et al . Prevalence of interatrial septal aneurysm in newborns and their natural course.  Pediatr Cardiol. 2006;  27 343-346
    Google Scholar
  • 16 Papa M, Fragasso G, Camesasca C. et al . Prevalence and prognosis of atrial septal aneurysm in high risk fetuses without structural heart defects.  Ital Heart J. 2002;  3 318-321
    Google Scholar
  • 17 Fujiwara M, Sase M, Kondou O. et al . Congenital aneurysm of the muscular interventricular septum in a fraternal case diagnosed by fetal echocardiography.  Pediatr Cardiol. 2001;  22 353-356
    Google Scholar
  • 18 Espinoza J, Kalache K, Gonçalves L F. et al . Prenatal diagnosis of membranous ventricular septal aneurysms and their association with absence of atrioventricular valve ‘offsetting’.  Ultrasound Obstet Gynecol. 2004;  24 787-792
    Google Scholar
  • 19 Lund J T, Jensen M B, Hjelms E. Aneurysm of the ductus arteriosus. A review of the literature and the surgical implications.  Eur J Cardiothorac Surg. 1991;  5 566-570
    Google Scholar
  • 20 Puder K S, Sherer D M, Ross R D. et al . Prenatal ultrasonographic diagnosis of ductus arteriosus aneurysm with spontaneous neonatal closure.  Ultrasound Obstet Gynecol. 1995;  5 342-345
    Google Scholar
  • 21 Jan S L, Hwang B, Fu Y C. et al . Isolated neonatal ductus arteriosus aneurysm.  J Am Coll Cardiol. 2002;  39 342-347
    Google Scholar
  • 22 Dyamenahalli U, Smallhorn J F, Geva T. et al . Isolated ductus arteriosus aneurysm in the fetus and infant: a multi-institutional experience.  J Am Coll Cardiol. 2000;  36 262-269
    Google Scholar
  • 23 Stadié R, Geipel A, Breuer J. et al . Prenatal diagnosis of an isolated aneurysm of the ascending aorta.  Ultrasound Obstet Gynecol. 2006;  27 233-234
    Google Scholar
  • 24 el Habbal M H. Cardiovascular manifestations of Marfan’s syndrome in the young.  Am Heart J. 1992;  123 752-727
    Google Scholar
  • 25 Gembruch U, Steil E, Redel D A. et al . Prenatal diagnosis of a left ventricular aneurysm.  Prenat Diagn. 1990;  10 203-209
    Google Scholar
  • 26 Goncalves L F, Simms J, Jeanty P. Aneurysm of the left ventricle.  Fetus. 1992;  1 7-10
    Google Scholar
  • 27 Grethel E J, Hornberger L K, Farmer D L. Prenatal and postnatal management of a patient with pentalogy of Cantrell and left ventricular aneurysm. A case report and literature review.  Fetal Diagn Ther. 2007;  22 269-273
    Google Scholar
  • 28 Di Bernardo S, Sekarski N, Meijboom E. Left ventricular diverticulum in a neonate with Cantrell syndrome.  Heart. 2004;  90 1320
    Google Scholar
  • 29 Pipitone S, Sperandeo V, Mongiovi M. et al . Prenatal diagnosis of ventricular aneurysm: a report of two cases and a review.  Prenat Diagn. 2002;  22 131-136
    Google Scholar
  • 30 Krasemann T, Gehrmann J, Fenge H. et al . Ventricular aneurysm or diverticulum? Clinical differential diagnosis.  Pediatr Cardiol. 2001;  22 409-411
    Google Scholar
  • 31 Hung J H, Lu J H, Hung C Y. Prenatal diagnosis of atrial septal aneurysm.  J Clin Ultrasound. 2008;  36 51-52
    Google Scholar
  • 32 Lund J T, Hansen D, Brocks V. et al . Aneurysm of the ductus arteriosus in the neonate: three case reports with a review of the literature.  Pediatr Cardiol. 1992;  13 222-226
    Google Scholar
  • 33 Tseng J J, Jan S L. Fetal echocardiographic diagnosis of isolated ductus arteriosus aneurysm: a longitudinal study from 32 weeks of gestation to term.  Ultrasound Obstet Gynecol. 2005;  26 50-56
    Google Scholar
  • 34 Tongsong T, Chanprapaph P, Sittiwangkul R. et al . Rupture of fetal ductus arteriosus aneurysm.  Obstet Gynecol. 2005;  105 1275-1278
    Google Scholar
  • 35 Jackson C M, Sandor G G, Lim K. et al . Diagnosis of fetal ductus arteriosus aneurysm: importance of the three-vessel view.  Ultrasound Obstet Gynecol. 2005;  26 57-62
    Google Scholar
  • 36 Lee W, Allan L, Carvalho J S. et al . ISUOG consensus statement: what constitutes a fetal echocardiogram?.  Ultrasound Obstet Gynecol. 2008;  32 239-242
    Google Scholar
  • 37 Chaoui R, Heling K, Mielke G. et al . Quality standards of the DEGUM for performance of fetal echocardiography.  Ultraschall in Med. 2008;  29 197-200
    Google Scholar
  • 38 Axt-Fliedner R, Chiriac A, Gembruch U. First and early second trimester fetal heart scanning.  Ultraschall in Med. 2009;  30 364-375
    Google Scholar
  • 39 Chaoui R, Hoffmann J, Heling K S. Three-dimensional (3D) and 4D color Doppler fetal echocardiography using spatio-temporal image correlation (STIC).  Ultrasound Obstet Gynecol. 2004;  23 535-545
    Google Scholar
  • 40 Chiang Y C, Yang C K, Shih J C. et al . Prenatal diagnosis of congenital left ventricular aneurysm by four-dimensional ultrasonography with spatio-temporal image correlation (STIC).  Ultrasound Obstet Gynecol. 2006;  28 345-347
    Google Scholar
  • 41 Johnson J A, Ryan G, Toi A. et al . Prenatal diagnosis of a fetal ventricular diverticulum associated with pericardial effusion: successful outcome following pericardiocentesis.  Prenat Diagn. 1996;  16 954-957
    Google Scholar
  • 42 Sharma J R, Oforl-Amanfo G, Marboe C. et al . Congenital left ventricular aneurysm with pericardial effusion: prenatal diagnosis, surgical management and follow-up.  Pediatr Cardiol. 2002;  23 458-461
    Google Scholar
  • 43 McAuliffe F M, Hornberger L K, Johnson J. et al . Cardiac diverticulum with pericardial effusion: report of two new cases treated by in-utero pericardiocentesis and a review of the literature.  Ultrasound Obstet Gynecol. 2005;  25 401-404
    Google Scholar
  • 44 Bernasconi A, Delezoide A L, Menez F. et al . Prenatal rupture of a left ventricular diverticulum: a case report and review of the literature.  Prenat Diagn. 2004;  24 504-507
    Google Scholar
  • 45 Mielke G, Peukert U, Krapp M. et al . Fetal and transient neonatal right heart dilatation with severe tricuspid valve insufficiency in association with abnormally S-shaped kinking of the ductus arteriosus.  Ultrasound Obstet Gynecol. 1995;  5 338-341
    Google Scholar
  • 46 Brown D L, Benson C B. The S-shaped ductus arteriosus.  Ultrasound Obstet Gynecol. 1995;  6 372
    Google Scholar
  • 47 Benson C B, Brown D L, Doubilet P M. et al . Increasing curvature of the normal fetal ductus arteriosus with advancing gestational age.  Ultrasound Obstet Gynecol. 1995;  5 95-97
    Google Scholar
  • 48 Cavallé-Garrido T, Cloutier A, Harder J. et al . Evolution of fetal ventricular aneurysms and diverticula of the heart: an echocardiographic study.  Am J Perinatol. 1997;  14 393-400
    Google Scholar
  • 49 Tongprasert F, Tongsong T, Sittiwangkul R. Prenatal sonographic diagnosis of congenital ductus arteriosus aneurysm: a case report.  J Med Assoc Thai. 2005;  88 541-544
    Google Scholar
  • 50 Jan S L, Hwang B, Fu Y C. et al . Initial clinical experience of real-time three-dimensional echocardiography in neonates with isolated congenital ductus arteriosus aneurysm.  Int J Cardiol. 2005;  105 300-305
    Google Scholar
  • 51 Toro L, Weintraub R G, Shiota T. et al . Relation between persistent atrial arrhythmias and redundant septum primum flap (atrial septal aneurysm) in fetuses.  Am J Cardiol. 1994;  73 711-713
    Google Scholar

Dr. Jan Weichert

Ob/Gyn, Division of Prenatal Medicine, University of Schleswig-Holstein, Campus Luebeck

Ratzburger Allee 160

23538 Luebeck

Germany

Telefon: ++ 49/4 51/5 00 21 49

Fax: ++ 49/4 51/5 00 24 30

eMail: jan.weichert@uk-sh.de

      >