Fetal Congenital Cardiac Diverticulum with Pericardial Effusion: A Case Treated by Urgent Thoracic Surgery

Abstract

A healthy 26-year-old woman, gravida 2 para 2 aborta 0, with a good course of pregnancy. An ultrasound done at 35 weeks of gestation was normal. In a routine third trimester ultrasound, done at 36 weeks of gestation, the fetus presented with a minimal pericardial effusion.The second day, the ultrasound was repeated by another obstetrician, with the same minimal cardiac effusion, a good heart rate and normal systolic function.On the same afternoon, the mother was referred to a pediatric cardiologist for assessment. An ultrasound done showed that the pericardial effusion had become enormous, causing cardiac tamponade and severe bradycardia (30 beats/min), without architectural anomalies (Figure 1).During the exam, the cardiologist observed that the effusion, previously hypo echoic, was progressively becoming hyper echoic, before turning into a complete hyper echoic effusion 10 minutes after (Figure 2).These results proved that the fetus was experiencing an active pericardial bleeding at the time of the ultrasound.Considering the life-threatening nature of the situation, the mother was sent to Hotel Dieu de France for an urgent C-section.An obstetrician, a neonatal pediatrician and a pediatric cardiac surgeon along with the pediatric cardiologist stood ready to handle the case.A C-section was performed and the baby girl was born with an Apgar score of 7 and 9, at 1 and 5 minutes of birth respectively. A cardiac ultrasound done at birth showed the same hyper echoic structure, surrounded by a new pericardial effusion.In view of the case, the C-section was exceptionally performed in the cardio-vascular operating theater so that the newborn can be directly transferred to the adjacent operating room.At the start of surgery, the newborn was hemodynamically unstable. As soon as the pericardial effusion was drained (30 The fetus presented with a large cardiac effusion one day before his birth, and an active pericardial bleeding with tamponade and severe bradycardia right before the urgent C-section. Drainage of the effusion done right after the delivery, with good neonatal outcome.