Neonatal Tuberous Sclerosis and Multiple Cardiac Arrhythmias
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An infant female was born at term with a presumptive diagnosis of tuberous sclerosis. Fetal echocardiograms had demonstrated multiple cardiac masses suggestive of rhabdomyomas (Figures 1 and 2⇓), and a fetal magnetic resonance image suggested the presence of brain lesions. An urgent Cesarean section was performed at term due to an irregular tachycardia. Postnatal echocardiograms demonstrated multiple cardiac masses, with large lesions along the lateral wall of the right atrium, the right ventricular apex and at the atrioventricular septum (Figure 3). Intracavitary obstruction was not apparent, but a smaller rhabdomyoma seen under the pulmonary valve caused mild right ventricular outflow tract obstruction. A cranial ultrasound demonstrated multiple echogenic foci, confirming the diagnosis of tuberous sclerosis, and a subsequent computed tomography scan of the brain delineated these lesions more clearly (Figure 4).