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Cardiac abnormalities associated with hydrops fetalis
1Department of Pediatrics and Medicine, University of Cincinnati College of Medicine, OH, USA.
Insights
Cardiovascular issues, including structural defects and arrhythmias, are linked to 26% of hydrops fetalis cases. Fetal tachyarrhythmias are the most treatable cardiac cause, offering a better prognosis for affected infants.
Area of Science:
- Perinatology
- Fetal Cardiology
- Pediatric Cardiology
Background:
- Hydrops fetalis is a serious condition characterized by excessive fluid accumulation in fetal tissues and organs.
- Cardiovascular abnormalities represent a significant, though not fully understood, etiology in a notable percentage of hydrops fetalis cases.
Purpose of the Study:
- To review the spectrum of cardiovascular abnormalities associated with hydrops fetalis.
- To elucidate the mechanisms by which cardiac conditions lead to hydrops fetalis.
- To assess the treatability and prognostic implications of cardiac causes of hydrops fetalis.
Main Methods:
- Literature review of modern era case reports and studies on hydrops fetalis and associated cardiovascular conditions.
- Analysis of reported cardiovascular abnormalities, including structural defects, arrhythmias, tumors, and inflammatory/ischemic conditions.
- Evaluation of proposed pathophysiological mechanisms linking cardiac dysfunction to hydrops fetalis.
Main Results:
- Cardiovascular abnormalities are identified in 26% of hydrops fetalis cases.
- Associated conditions range from structural lesions to arrhythmias, tumors, myopathy, infection, infarction, and arterial calcification.
- Lesions causing right atrial pressure/volume overload and fetal tachyarrhythmias are strongly associated with hydrops fetalis.
Conclusions:
- Cardiac abnormalities are a significant cause of hydrops fetalis, acting through mechanisms like volume overload and impaired cardiac function.
- Fetal tachyarrhythmias represent the most treatable cardiac etiology, offering a potential for improved outcomes.
- While bradyarrhythmias are less commonly implicated and harder to treat, a comprehensive cardiac evaluation is crucial for managing hydrops fetalis.
Abstract:
Cardiovascular abnormalities are associated with hydrops fetalis in 26% of cases reported in the modern era. These include not only structural abnormalities, but also cardiac arrhythmias, failure, tumors, myopathy, infection, inflammation, infarction, and arterial calcification. Cardiac structural abnormalities may be causative or seen only in association with hydrops fetalis. Structural lesions that result in right atrial pressure or volume overload seem to be most commonly associated with hydrops fetalis. Fetal cardiac tumors, cardiomyopathy, myocarditis, myocardial infarction, and arterial calcification probably result in hydrops fetalis by a similar mechanism. Fetal tachyarrhythmia has been shown to result in elevation of atrial pressure and atrial natriuretic peptide. Fetal tachyarrhythmias are the most treatable of cardiac causes of hydrops fetalis. Fetal bradyarrhythmias are less easily treatable and less certainly a causative mechanism of hydrops fetalis.