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Z Geburtshilfe Neonatol 2017; 221(02): 67-72
DOI: 10.1055/s-0042-123825
Review
© Georg Thieme Verlag KG Stuttgart · New York

Cardiac Etiologies of Hydrops Fetalis

Shi-Min Yuan
1   Department of Cardiothoracic Surgery, The First Hospital of Putian, Teaching Hospital, Fujian Medical University, Putian, China
› Author Affiliations
Further Information

Publication History

received  17 October 2016

accepted  after revision 27 November 2016

Publication Date:
23 May 2017 (online)

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Abstract

Cardiac etiologies of hydrops fetalis have been a topic of concern due to challenging perinatal management. The common cardiac etiologies leading to hydrops fetalis include structural cardiac anomalies, cardiac dysrhythmias, cardiac tumors, cardiomyopathy and myocarditis. The mechanisms of cardiogenic hydrops fetalis may be: 1) elevation of atrial pressure and volume overload, 2) decrease of cardiac output, and 3) development of congestive heart failure. The diagnosis of hydrops fetalis was usually made at 19–36 gestational weeks, when ultrasound is a highly effective diagnostic method. Intrauterine interventions for certain congenital heart defects, maternal transplacental or direct fetal medications and fetal pacing placement for cardiac arrhythmias, and fetal or postnatal tumor resections are important progressions of etiologic treatment for hydrops fetalis. Treatment strategies for hydrops fetalis per se are usually ultrasound-guided pericardiocentesis and feto-amniotic shunting, whereas reaccumulation may require further interventions in utero or postnatally. Hydrops fetalis often carries a poor prognosis, and mortality remains high. Current developments in the management of hydrops fetalis should encourage physicians to attempt further fetal interventions.

Key words

cardiac arrhythmias - congenital heart defects - hydrops fetalis
 

  • References

  • 1 de Haan TR, Oepkes D, Beersma MCF. et al. Chapter 2. Aetiology, diagnosis and treatment of hydrops foetalis. Curr Pediatr Rev 2005; 1: 63-72
    CrossrefPubMedGoogle Scholar
  • 2 Hasnani-Samnani Z, Mahmoud MI, Farid I. et al. Non-immune hydrops: Qatar experience. J Matern Fetal Neonatal Med 2013; 26: 449-453
    CrossrefPubMedGoogle Scholar
  • 3 Désilets V, Audibert F. Society of Obstetrician and Gynaecologists of Canada. Investigation and management of non-immune fetal hydrops. J Obstet Gynaecol Can 2013; 35: 923-938
    PubMedGoogle Scholar
  • 4 Speer ME. Immune and non-immune hydrops fetalis. Neonatol Today 2006; 1: 1-6 http://www.neonatologytoday.net/newsletters/nt-aug06.pdf
    PubMedGoogle Scholar
  • 5 Ismail KM, Martin WL, Ghosh S. et al. Etiology and outcome of hydrops fetalis. J Matern Fetal Med 2001; 10: 175-181
    PubMedGoogle Scholar
  • 6 Sohan K, Carroll SG, De La Fuente S. et al. Analysis of outcome in hydrops fetalis in relation to gestational age at diagnosis, cause and treatment. Acta Obstet Gynecol Scand 2001; 80: 726-730
    CrossrefPubMedGoogle Scholar
  • 7 Kayiran P, Gürsoy T, Gürakan B. Non immune hydrops fetalis: two premature infants with favorable outcome. Marmara Med J 2013; 26: 168-170 10.5472/MMJ.2013.02956.0
    PubMedGoogle Scholar
  • 8 Society for Maternal-Fetal Medicine (SMFM). Norton ME, Chauhan SP, Dashe JS. Society for maternal-fetal medicine (SMFM) clinical guideline #7: nonimmune hydrops fetalis. Am J Obstet Gynecol 2015; 212: 127-139
    CrossrefPubMedGoogle Scholar
  • 9 Liu CA, Huang HC, Chou YY. Retrospective analysis of 17 liveborn neonates with hydrops fetalis. Chang Gung Med J 2002; 25: 826-831
    PubMedGoogle Scholar
  • 10 De Geeter B, Kretz JG, Nisand I. et al. Intrapericardial teratoma in a newborn infant: use of fetal echocardiography. Ann Thorac Surg 1983; 35: 664-666
    CrossrefPubMedGoogle Scholar
  • 11 Knilans TK. Cardiac abnormalities associated with hydrops fetalis. Semin Perinatol 1995; 19: 483-492
    CrossrefPubMedGoogle Scholar
  • 12 Joseph DZ, Igashi J, Joseph G. et al. The role of ultrasonography in the diagnosis of hydrops fetalis: a case report. Int J Med Sci Res Pract 2015; 2: 153-155
    PubMedGoogle Scholar
  • 13 Donofrio MT, Moon-Grady AJ, Hornberger LK. et al. American Heart Association Adults With Congenital Heart Disease Joint Committee of the Council on Cardiovascular Disease in the Young and Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and Council on Cardiovascular and Stroke Nursing. Diagnosis and treatment of fetal cardiac disease: a scientific statement from the American Heart Association. Circulation 2014; 129: 2183-2242 Erratum in Circulation. 2014; 129: e512
    CrossrefPubMedGoogle Scholar
  • 14 Laneri GG, Claassen DL, Scher MS. Brain lesions of fetal onset in encephalopathic infants with nonimmune hydrops fetalis. Pediatr Neurol 1994; 11: 18-22
    PubMedGoogle Scholar
  • 15 Glenn OA, Barkovich J. Magnetic resonance imaging of the fetal brain and spine: an increasingly important tool in prenatal diagnosis: part 2. AJNR Am J Neuroradiol 2006; 27: 1807-1814
    PubMedGoogle Scholar
  • 16 Pruksanusak N, Suntharasaj T, Suwanrath C. et al. Fetal cardiac rhabdomyoma with hydrops fetalis: report of 2 cases and literature review. J Ultrasound Med 2012; 31: 1821-1824
    CrossrefPubMedGoogle Scholar
  • 17 Ng ZM, Seet MJ, Erng MN. et al. Nonimmune hydrops fetalis in a children’s hospital: a six-year series. Singapore Med J 2013; 54: 487-490
    CrossrefPubMedGoogle Scholar
  • 18 McFadden DE, Taylor GP. Cardiac abnormalities and nonimmune hydrops fetalis: a coincidental, not causal, relationship. Pediatr Pathol 1989; 9: 11-17
    CrossrefPubMedGoogle Scholar
  • 19 Chi JG. Hydrops fetalis (an analysis of 34 autopsy cases). Seoul J Med 1988; 29: 39-44
    PubMedGoogle Scholar
  • 20 Tongsong T, Wanapirak C, Piyamongkol W. et al. Fetal ventricular shortening fraction in hydrops fetalis. Obstet Gynecol 2011; 117: 84-91 10.1097/AOG.0b013e3181fc3887
    CrossrefPubMedGoogle Scholar
  • 21 Kumbasar S, Salman S, Yumru AE. et al. Successful treatment of fetal atrial flutter with sotalol in a non-hydrops fetalis. JAREM 2016; 6: 49-52 10.5152/jarem.2015.723
    CrossrefPubMedGoogle Scholar
  • 22 Simpson JM, Sharland GK. Fetal tachycardias: management and outcome of 127 consecutive cases. Heart 1998; 79: 576-581
    CrossrefPubMedGoogle Scholar
  • 23 Kamil D, Tepelmann J, Berg C. et al. Spectrum and outcome of prenatally diagnosed fetal tumors. Ultrasound Obstet Gynecol 2008; 31: 296-302
    CrossrefPubMedGoogle Scholar
  • 24 Touman L, Reyes G, Aupont J et al. Diagnosis and management of a case of supraventricular tachycardia in DCDA twin with non-immune hydrops fetalis. https://fetalmedicine.org/abstracts/2015/var/pdf/abstracts/1030.pdf
    PubMed
  • 25 Krapp M, Baschat AA, Gembruch U. et al. Flecainide in the intrauterine treatment of fetal supraventricular tachycardia. Ultrasound Obstet Gynecol 2002; 19: 158-164
    CrossrefPubMedGoogle Scholar
  • 26 Frohn-Mulder IM, Stewart PA, Witsenburg M. et al. The efficacy of flecainide versus digoxin in the management of fetal supraventricular tachycardia. Prenat Diagn 1995; 15: 1297-1302
    CrossrefPubMedGoogle Scholar
  • 27 Jaeggi ET, Carvalho JS, De Groot E. et al. Comparison of transplacental treatment of fetal supraventricular tachyarrhythmias with digoxin, flecainide, and sotalol: results of a nonrandomized multicenter study. Circulation 2011; 124: 1747-1754
    CrossrefPubMedGoogle Scholar
  • 28 Oudijk MA, Michon MM, Kleinman CS. et al. Sotalol in the treatment of fetal dysrhythmias. Circulation 2000; 101: 2721-2726
    CrossrefPubMedGoogle Scholar
  • 29 Muniswaran G, Japaraj RP, Asri Ranga AR. et al. Intrauterine management of fetal supraventricular tachycardia (SVT) with cardiac failure. Med J Malaysia 2015; 70: 371-372
    PubMedGoogle Scholar
  • 30 Anandakumar C, Biswas A, Chew SS. et al. Direct fetal therapy for hydrops secondary to congenital atrioventricular heart block. Obstet Gynecol 1996; 87: 835-837
    PubMedGoogle Scholar
  • 31 Boldt T. Echocardiography as a diagnostic tool in the fetal and neonatal period: impact on short- and long-term outcome [Dissertation]. Helsinki, Finland: Hospital for Children and Adolescents, University of Helsinki; 2004: 1-81 ethesis.helsinki.fi/julkaisut/laa/kliin/vk/boldt/echocard.pdf
    Google Scholar
  • 32 Malcomson RDG, Keeling JW. Fetal hydrops. In: Keeling JW, Khong TY. (eds.) Fetal and Neonatal Pathology. London: Springer; 2007: 297-326 http://link.springer.com/chapter/10.1007/978-1-84628-743-5_14
    CrossrefGoogle Scholar
  • 33 Cetiner N, Altunyuva Usta S, Akalın F. Coronary arteriovenous fistula causing hydrops fetalis. Case Rep Obstet Gynecol 2014; 2014: 487281 10.1155/2014/487281
    PubMedGoogle Scholar
  • 34 Sahn DJ, Shenker L, Reed KL. et al. Prenatal ultrasound diagnosis of hypoplastic left heart syndrome in utero associated with hydrops fetalis. Am Heart J 1982; 104: 1368-1372
    CrossrefPubMedGoogle Scholar
  • 35 Nakata M, Anno K, Matsumori LT. et al. Successful treatment of supraventricular tachycardia exhibiting hydrops fetalis with flecainide acetate. A case report. Fetal Diagn Ther 2003; 18: 83-86
    CrossrefPubMedGoogle Scholar
  • 36 Nakata M, Fujiwara M, Ishikawa Y. et al. Prenatal diagnosis and management for a large fetal cardiac tumor complicated with hydrops fetalis. J Obstet Gynaecol Res 2005; 31: 476-479
    CrossrefPubMedGoogle Scholar
  • 37 Soltan MH, Keohane C. Hydrops fetalis due to congenital cardiac rhabdomyoma. Case report. Br J Obstet Gynaecol 1981; 88: 771-773
    CrossrefPubMedGoogle Scholar
  • 38 Czernik C, Stiller B, Hübler M. et al. Hydrops fetalis caused by a large intrapericardial teratoma. Ultrasound Obstet Gynecol 2006; 28: 973-976
    CrossrefPubMedGoogle Scholar
  • 39 Devlieger R, Hindryckx A, Van Mieghem T. et al. Therapy for foetal pericardial tumours: survival following in utero shunting, and literature review. Fetal Diagn Ther 2009; 25: 407-412 10.1159/000236156
    CrossrefPubMedGoogle Scholar
  • 40 Grebille AG, Mitanchez D, Benachi A. et al. Pericardial teratoma complicated by hydrops: successful fetal therapy by thoracoamniotic shunting. Prenat Diagn 2003; 23: 735-739
    CrossrefPubMedGoogle Scholar
  • 41 Bader R, Hornberger LK, Nijmeh LJ. et al. Fetal pericardial teratoma: presentation of two cases and review of literature. Am J Perinatol 2006; 23: 53-58
    Article in Thieme ConnectPubMedGoogle Scholar
  • 42 Sydorak RM, Kelly T, Feldstein VA. et al. Prenatal resection of a fetal pericardial teratoma. Fetal Diagn Ther 2002; 17: 281-285
    CrossrefPubMedGoogle Scholar
  • 43 Tollens T, Casselman F, Devlieger H. et al. Fetal cardiac tamponade due to an intrapericardial teratoma. Ann Thorac Surg 1998; 66: 559-560
    CrossrefPubMedGoogle Scholar
  • 44 Orsini LF, Pilu G, Calderoni P. et al. Intravascular intrauterine transfusion for severe erythroblastosis fetalis using different techniques. Fetal Ther 1988; 3: 50-59
    CrossrefPubMedGoogle Scholar
  • 45 Lingman G, Stangenberg M, Legarth J. et al. Albumin transfusion in non-immune fetal hydrops: Doppler ultrasound evaluation of the acute effects on blood circulation in the fetal aorta and the umbilical arteries. Fetal Ther 1989; 4: 120-125
    CrossrefPubMedGoogle Scholar
  • 46 Gardiner HM, Wimalasundera R, Pasquini L. et al. Images in cardiovascular medicine. Pericardiocentesis at 14 weeks: effective treatment of pericardial effusion complicating right ventricular diverticulum. Circulation 2005; 112: e120 10.1161/CIRCULATIONAHA.104.503250
    CrossrefPubMedGoogle Scholar
  • 47 Benatar A, Vaughan J, Nicolini U. et al. Prenatal pericardiocentesis: its role in the management of intrapericardial teratoma. Obstet Gynecol 1992; 79: 856-859
    PubMedGoogle Scholar
  • 48 Michailidis GD, Hourihane JO, Sievers R. et al. In-utero pericardiocentesis to treat fetal hydrops caused by X-linked chronic granulomatous disease. Ultrasound Obstet Gynecol 2006; 28: 117-119 10.1002/uog.2831
    PubMedGoogle Scholar
  • 49 Thorp JA, Geidt A, Gelatt M. et al. Decompression of fetal cardiac tamponade caused by congenital capillary hemangioma of the pericardium. Obstet Gynecol 2000; 96: 816-817
    PubMedGoogle Scholar
  • 50 Tomek V, Vlk R, Tláskal T. et al. Successful pericardio-amniotic shunting for fetal intrapericardial teratoma. Pediatr Cardiol 2010; 31: 1236-1238. 10.1007/s00246-010-9774-x
    CrossrefPubMedGoogle Scholar
  • 51 Steffensen TS, Quintero RA, Kontopoulos EV. et al. Massive pericardial effusion treated with in utero pericardioamniotic shunt in a fetus with intrapericardial teratoma. Fetal Pediatr Pathol 2009; 28: 216-231
    CrossrefPubMedGoogle Scholar
  • 52 Yuan SM. Fetal cardiac interventions. Pediatr Neonatol 2015; 56: 81-87 10.1016/j.pedneo.2014.04.007
    CrossrefPubMedGoogle Scholar
  • 53 Carpenter Jr RJ, Strasburger JF, Garson Jr. A. et al. Fetal ventricular pacing for hydrops secondary to complete atrioventricular block. J Am Coll Cardiol 1986; 8: 1434-1436
    CrossrefPubMedGoogle Scholar
  • 54 Yuan SM. Fetal cardiac interventions: an update of therapeutic options. Rev Bras Cir Cardiovasc 2014; 29: 388-395
    PubMedGoogle Scholar
  • 55 Maxwell D, Allan L, Tynan MJ. Balloon dilatation of the aortic valve in the fetus: a report of two cases. Br Heart J 1991; 65: 256-258
    CrossrefPubMedGoogle Scholar
  • 56 Marshall AC, Levine J, Morash D. et al. Results of in utero atrial septoplasty in fetuses with hypoplastic left heart syndrome. Prenat Diagn 2008; 28: 1023-1028
    CrossrefPubMedGoogle Scholar
  • 57 Riskin-Mashiah S, Moise Jr KJ, Wilkins I. et al. In utero diagnosis of intrapericardial teratoma: a case for in utero open fetal surgery. Prenat Diagn 1998; 18: 1328-1330
    CrossrefPubMedGoogle Scholar
  • 58 Yuan SM, Humuruola G. Fetal cardiac interventions: clinical and experimental research. Postepy Kardiol Interwencyjnej 2016; 12: 99-107 10.5114/aic.2016.59359
    PubMedGoogle Scholar
  • 59 Emmel M, Brockmeier K, Sreeram N. Rhabdomyoma as accessory pathway: electrophysiologic and morphologic confirmation. Heart 2004; 90: 43
    CrossrefPubMedGoogle Scholar
  • 60 Castillo RA, Devoe LD, Hadi HA. et al. Nonimmune hydrops fetalis: clinical experience and factors related to a poor outcome. Am J Obstet Gynecol 1986; 155: 812-816
    CrossrefPubMedGoogle Scholar
  • 61 Carvalho JS. 8.2. Fetal dysrhythmias: clinical management. In: Kilby MD, Oepkes DK, Johnson A. (eds.) Fetal Therapy: Scientific Basis and Critical Appraisal of Clinical Benefits. Cambridge: Cambridge University Press; 2013: 87-99
    Google Scholar