Complete foetal atrioventricular block: diagnostic and therapeutic approach. Case report in Bogotá, Colombia, and review of the literature
DOI:
https://doi.org/10.18597/rcog.3097Keywords:
Bradyarrhythmia, atrioventricular block, systemic lupus erythematosusAbstract
Objective: To report a case of complete congenital atrioventricular block and to review the literatura on diagnosis and treatment.
Materials and methods: Case report of a 27-year-old pregnant woman who came to a high complexity general hospital with a 33-week singleton gestation and a diagnosis of complete atrioventricular block and secondary dilated cardiomyopathy. Response to initial prenatal management with beta-mimetic therapy was poor, and the woman had to be taken to Cesarean section. The newborn required implantation of a ventricular pacemaker on the first day of life, with excellent results at 1-year follow-up. A review of the literature published in Medline, Lilacs and SciELO databases was conducted using the terms “foetal complete atrioventricular block”, “congenital complete heart block,” limited to articles published between 2000 and 2016 in Spanish and English.
Results: Overall, 21 publications were retrieved: seven case reports, ten reviews of the literatura and four cohort studies. Diagnosis is based on the foetal echocardiographic scan to determine the PR interval and the atrioventricular ratio, and to detect intracardiac abnormalities, including valvular regurgitation, myocardial/valvular hyperechogenicity, endocardial fibroelastosis, premature atrial contractions, and pericardial effusion. In terms of prenatal treatment, corticosteroids and beta-mimetics are the most widely used medications. Treatment of severe neonatal refractory bradyarrhythmia may require pacemaker implantation as definitive management.
Conclusion: Congenital third-degree AV bock requires early diagnosis and timely treatment, because associated perinatal morbidity and mortality are high. Studies with better methodological quality are needed in order to endorse other promising therapeutic options and approaches.Author Biographies
Diana Cecilia Poveda-Rojas
Ginecoobstetra. Universidad Militar Nueva Granada- Unidad de Ginecología y Obstetricia, Hospital Universitario Clínica San Rafael. Bogotá (Colombia). dianeporo718@hotmail.com
Natalia Vélez-Tirado
Leonardo Bonilla-Cortes
Juan Pablo Rozo-Galindo
References
Gratacós Martínez G. Cardiología fetal. Madrid: Marbán; 2015.
Matta MJ, Cuneo BF. Doppler echocardiography for managing fetal cardiac arrhythmia. Clin Obstet Gynecol. 2010;53:899-914. https://doi.org/10.1097/GRF.0b013e3181fbb747
Jaeggi ET, Friedberg M. Arrhythmias during pregnancy. Diagnosis and Management of Fetal Bradyarrhythmias. Pacing Clin Electrophysiol. 2008;31:S50-3. https://doi.org/10.1111/j.1540-8159.2008.00957.x
DiMaio MA, Faix JD. Fetal atrioventricular heart block. Stanford University medical center. Clinical Chemistry. 2014;60:1153-7. https://doi.org/10.1373/clinchem.2013.212035.
Lai J, Clark TJ, Tan JH, Delaney S, Jolley JA. Ultrasound findings in fetal congenital heart block associated with maternal anti-Ro/SSA and Anti-La/SSB antibodies. Ultrasound Q.2015;31:34-
https://doi.org/10.1097/RUQ.0000000000000112.
Santos-Pardo I, Villuendas R, Salvador-Corres I, Martínez-Morillo M, Olivé A, Bayes-Genis A. Anti-Ro/SSA antibodies and cardiac rhythm disturbances: Present and future perspectives. Int J Cardiol. 2015;184:244-50. https://doi.org/10.1016/j.ijcard.2014.11.002
Buyon JP, Clancy RM. From antibody insult to fibrosis in neonatal lupus – The heart of the matter. 2003;5:266-70. https://doi.org/10.1186/ar763.
Krishnan A, Ar ya B, Moak JP, Donofrio MT. Outcomes of fetal echocardiographic surveillance in anti-SSA exposed fetuses at a large fetal cardiology center. Prenat Diagn. 2014;34:1207-12. https://doi.org/10.1002/pd.4454.
Brucato A, Frassi M, Franceschini F, Cimaz R, Faden D, Pisoni MP, et al. Risk of congenital complete heart block in newborns of mothers with anti-Ro/SSA antibodies detected by counterimmunoelectrophoresis: A prospective study of 100 women. Arthritis Rheum. 2001;44:1832-5. https://doi.org/10.1002/1529-0131(200108)44:8<1832::AIDART320>3.0.CO;2-C.
Díaz A, Serrano A, Guzmán M. Bloqueo aurículoventricular congénito completo. Reporte de un caso y revisión de la literatura. Rev Colomb Cardiol. 2008;15:35-42.
Eronen M, Sirèn MK, Ekblad H, Tikanoja T, Julkunen H, Paavilainen T. Short and Long-term outcome of children with congenital complete heart block diagnosed in utero or as a newborn. Pediatrics. 2000;106:86-91. https://doi.org/10.1542/peds.106.1.86
Jaeggi E, Laskin C, Hamilton R, Kingdom J, Silverman E. The importance of the level of maternal anti-Ro/SSA antibodies as a prognostic marker of the development of cardiac neonatal lupus erythematosus. A prospective study of 186 antibody-exposed fetuses and infants. J Am Coll Cardiol. 2010;55:2778-84. https://doi.org/10.1016/j.jacc.2010.02.042.
Llanos C. Recurrence rates of cardiac manifestations associated with neonatal lupus and maternal/fetal risk factors, Manuscript A, Cytokines P, Transplantation P. Arthritis Rheum. 2010;9:1-14.
Hickstein H, Külz T, Claus R, Stange J, Schmidt R. Autoimmune-associated congenital heart block: Treatment of the mother with immunoadsorption. Ther Apher Dial. 2005;9:148-53. https://doi.org/10.1111/j.1774-9987.2005.00226.x.
Trucco SM, Jaeggi E, Cuneo B, Moon-Grady AJ, Silverman E, Silverman N, et al. Use of intravenous gamma globulin and corticosteroids in the treatment of maternal autoantibody-mediated cardiomyopathy. J Am Coll Cardiol. 2011;57:715-23. https://doi:10.1016/j.jacc.2010.09.044.
Yan J, Varma SK, Malhotra A, Menahem S. Congenital complete heart block: Single tertiary center experience. Heart, Lung and Circulation. 2012;21:666-70. https://doi.org/10.1016/j.hlc.2012.05.784.
Ammiratti A, Silvetti MS, Di Carlo D, Saputo FA, Longoni A, Drago F. “De novo” biventricular pacing in two children with complete atrio-ventricular blockand severe ventricular dilatation: Early reverse remodeling. Int J Cardiol. 2012;160: e52-e53. https://doi.org/10.1016/j.ijcard.2012.03.032.
Buyon JP, Clancy RM, Friedman DM. Autoimmune associated congenital heart block: Integration of clinical and research clues in the management of the maternal fetal dyad at risk. J Intern Med. 2009;265:653-62. https://doi.org/10.1111/j.1365-2796.2009.02100.x.
Buyon JP. Neonatal lupus: Epidemiology, pathogenesis, clinical manifestations, and diagnosis [visitado 2017 Nov 21]. Disponible en: https://www.uptodate.com/contents/neonatal-lupus-epidemiology-pathogenesisclinical-manifestations-and-diagnosis.
Saxena A, Izmirly PM, Mendez B, Buyon JP, Friedman DM. Prevention and treatment in utero
of autoimmune-associated congenital heart block. Cardiol Rev. 2014;22:263-7. https://doi.org/10.1097/CRD.0000000000000026
Weber R, Stambach D, Jaeggi E. Diagnosis and management of common fetal arrhythmias. J Saudi Heart Assoc.. 2011;23:61-6. https://doi.org/10.1016/j.jsha.2011.01.008
Baruteau A, Perry E, Sanatani S, Horie M, Dubin A. Evaluation and management of bradycardia in neonates and children. Eur J Pediatr. 2016; 175:151-61. https://doi.org/10.1007/s00431-015-2689-z
How to Cite
Downloads
Downloads
Published
Issue
Section
| Article metrics | |
|---|---|
| Abstract views | |
| Galley vies | |
| PDF Views | |
| HTML views | |
| Other views | |
