We found the article “Giant Cardiac Rhabdomyoma with Mixed Atrial Tachycardia and
Nonsustained Ventricular Tachycardia in a Newborn with Tuberous Sclerosis”
published by Kyung Hee Kim and Ji-Eun Ban published in your highly valued journal to be
really intriguing [
1].
The tuberous sclerosis is a rare systemic genetic disease which affects multiple organs
and systems and requires precise diagnosis and a multidisciplinary treatment. According
to Zhang et al. the prenatal or early postnatal diagnosis provides an opportunity for
adequate treatment, which greatly improves the possibility of normal development of the
child [
2].
We agree with much of what the respected authors have stated. Based on our experience and
literature review, we would like to make some clarifications that would further enrich
the publication. In the article there is no clear information regarding the sequence and
the progress of the pregnancy, the age of the mother as well as weather she has other
diseased children. It is not mentioned whether other congenital anomalies (of the brain,
kidneys, etc.) are diagnosed prenatally in addition to the cardiac tumor.
It has been reported that the ultrasound examination is not always informative enough
regarding cerebral or kidney damage, therefore it is necessary to perform magnetic
resonance imaging to identify subependymal lesions, such as giant cell astrocytoma
[
3]. Prenatal fetal genetic examination is
advisable to detect large deletions of
TSC2 and
PKD1
genes [
3].
A parental genetic examination is also required for establishing whether the disease is
inherited or occur sporadically. The tuberous sclerosis is inherited in an autosomal
dominant manner with high penetrance, which would allow to make a prediction of a
possible subsequent pregnancy.
Pregnancies complicated by the presence of maternal or fetal tuberous sclerosis require
greater vigilance, and the mechanisms underlying the increased perinatal distress
require further studies [
2].
It is not clear by the article why an autopsy was not performed on the deceased child,
which would certainly have established both the histological nature of the heart tumor
and any additional pathological findings, as well as the cause of the fatal outcome of
the child.
The mentioned comments in no way detract from the value of the presented publication,
which emphasizes the diagnosis and treatment of atrial and ventricular
tachyarrhythmias.
Acknowledgments
Not applicable.
Conflict of Interest
-
No potential conflict of interest relevant to this article was reported.
Author Contribution
-
Conceptualization: Kitova T
Formal Analysis: Kitova T
Investigation: Uchikova E
Methodology: Uchikova E
Project Administration: Angelova P, Kitov B
Writing – Original Draft: Kitov B
Writing – Review & Editing: Kitova T, Angelova P, Uchikova E, Kitov
B
Ethics Approval and Consent to Participate
-
Not applicable.
References
- 1. Kim KH, Ban JE. Giant cardiac rhabdomyoma with mixed atrial tachycardia and
nonsustained ventricular tachycardia in a newborn with tuberous
sclerosis. Ewha Med J 2022;45((3)):e5.
- 2. Zhang AXD, Liang H, McEwen FS, Tye C, Woodhouse E, Underwood L, et al. Perinatal adversities in tuberous sclerosis complex: determinants
and neurodevelopmental outcomes. Dev Med Child Neurol 2022;64((10)):1237-1245.
- 3. Zhang YX, Meng H, Zhong DR, Jiang YX, Dai Q, Zhang H. Cardiac rhabdomyoma and renal cyst in a fetus: early onset of
tuberous sclerosis with renal cystic disease. J Ultrasound Med 2008;27((6)):979-982.
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