Document Detail


Congenital complete heart block: fetal management protocol, review of the literature, and report of the smallest successful pacemaker implantation.
MedLine Citation:
PMID:  14762451     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Fetuses with complete heart block have an increased mortality with most deaths occurring in utero or during infancy. The cardiac evaluation of these fetuses is difficult since the ventricular rate is low and the heart is dilated. We have implemented a strategy that includes the biophysical profile, which assesses fetal well-being, in combination with the cardiovascular profile that assesses cardiac function and the circulation. We present two cases of fetal complete heart block in which early delivery was recommended due to worsening cardiovascular profile scores. Biophysical profile scores were normal. Both babies were successfully treated, despite having risk factors that predicted poor outcomes. We hypothesize that our management protocol initiated intervention before fetal compromise, hydrops, and myocardial damage occurred. We recommend an evaluation of heart function in addition to an assessment of fetal well-being in fetuses with complete heart block. Early delivery should be considered if there is evidence of distress and/or deteriorating cardiac function.
Authors:
Mary T Donofrio; Scott D Gullquist; Inder D Mehta; William B Moskowitz
Publication Detail:
Type:  Case Reports; Journal Article; Review    
Journal Detail:
Title:  Journal of perinatology : official journal of the California Perinatal Association     Volume:  24     ISSN:  0743-8346     ISO Abbreviation:  J Perinatol     Publication Date:  2004 Feb 
Date Detail:
Created Date:  2004-02-11     Completed Date:  2004-06-14     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8501884     Medline TA:  J Perinatol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  112-7     Citation Subset:  IM    
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, Medical College of Virginia Hospital of Virginia Commonwealth University, Richmond, VA 23298, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Clinical Protocols
Dilatation, Pathologic
Female
Fetal Diseases / therapy*,  ultrasonography
Fetal Heart / ultrasonography
Gestational Age
Heart Block / congenital*,  therapy*,  ultrasonography
Heart Ventricles / pathology
Humans
Infant, Newborn
Infant, Premature
Infant, Premature, Diseases / therapy
Pacemaker, Artificial
Pregnancy
Ultrasonography, Doppler
Ultrasonography, Prenatal

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