Fetal cardiac rhabdomyoma: Two prenatally diagnosed cases with contrasting outcomes

Fetal cardiac rhabdomyoma is the most frequent primary cardiac tumor diagnosed in utero and carries a strong association with tuberous sclerosis complex. We present 2 prenatally diagnosed cases with contrasting postnatal outcomes. In the first case, a 28-year-old primigravida was diagnosed at 32 weeks with multiple intracardiac echogenic masses; the largest, a 22 mm polylobulated left ventricular lesion prolapsing through the mitral valve, caused hemodynamically significant obstruction requiring surgical resection at 15 days of life. In the second case, a 25-year-old primigravida with multiple masses detected at 22 weeks was followed conservatively; postnatal echocardiography demonstrated spontaneous regression with a favorable outcome. In both cases, initial neurological, imaging, dermatological, and genetic evaluations did not reveal evidence of tuberous sclerosis complex at the time of assessment. These cases illustrate the variable clinical course of fetal cardiac rhabdomyoma and underscore the importance of risk-stratified echocardiographic monitoring, individualized multidisciplinary management, and long-term surveillance for tuberous sclerosis complex regardless of initial evaluation results.