Successful Surgical Treatment of a 1,600 g Preterm with Cardiac Teratoma and Severe Fetal Hydrops

Introduction: We present a preterm patient born at gestational week 28+0 with a birth weight of 1,600 g with severe fetal hydrops caused by a cardiac tumor, which was successfully resected at our institution.

Clinical Summaries: The patient was prenatally diagnosed with a pericardial tumor and severe fetal hydrops. Lung maturation was initiated immediately and progressive worsening of cardiac filling and bradycardia required delivery within 24 hours after admission via cesarean section at a gestational age of 28 + 0 weeks. The hydropic patient with a total birth weight of 1,600 g was intubated and 60 mL of pericardial effusion was drained immediately at the neonatal intensive care unit. Subsequently, pleural effusions and ascites were drained. Inotropic support was necessary several days. Finally, due to recurrent chylous effusions not responding to low fat diet together with upper venous congestion, surgical resection of the tumor was indicated. The surgery was performed on day 12 by median sternotomy and a tumor of 5 × 3 × 2.5 cm was found adhesive to the outer wall of the aorta which could be resected in toto. The postoperative clinical course was very satisfying without any complications and extubation on the third day postsurgery. The histopathological analysis of the tumor revealed the diagnosis of an immature, cystic teratoma not indicated for further chemotherapeutic treatment. The further clinical course was excellent without any recurrence of pleural/pericardial effusions. Finally, the patient was discharged home at a gestational age of 38 weeks and with a body weight of 2,600 g.

Discussions: Teratoma is the second frequent of cardiac tumors, typically presenting with a cardiac mass and pericardial effusions in fetal echocardiograms. Manifestation prenatally is associated with poor outcome due to severe fetal hydrops. With respect to gestational age and decompensated heart failure, acute delivery and drainage of the pericardial effusion were the appropriate treatment in our patient. Relapse of pericardial effusion and progression of tumor size did not allow to wait for further growth of the preterm infant. Long-term prognosis is generally good not negatively influenced by immature elements and recurrence unlikely.

Conclusion: The presented patient is the smallest reported patient with successful resection of a cardiac teratoma. A fast and effective interdisciplinary management led to a successful treatment despite the presence of severe fetal hydrops.