Document Detail


Prenatal diagnosis of complete atrioventricular block associated with structural heart disease: combined experience of two tertiary care centers and review of the literature.
MedLine Citation:
PMID:  15937969     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To review the pattern of presentation, management and outcome of fetal complete atrioventricular block (CAVB) associated with major structural congenital heart disease (CHD), when compared to isolated CAVB. METHODS: Retrospective analysis of the medical records and echocardiograms of all CAVB cases, diagnosed prenatally at two tertiary care centers between the years 1990 and 2002. RESULTS: Of a total of 59 consecutive fetal cases of CAVB, 24 (41%) had underlying major CHD, mainly left isomerism (n = 18) and congenitally corrected transposition of the great arteries (cc-TGA) (n = 3). When compared to isolated CAVB (n = 35), cases with CHD were detected earlier (21 +/- 6 vs. 26 +/- 6 weeks; P < 0.02) and-despite comparable heart rates-more often had fetal hydrops (38% vs. 9%; P < 0.02), while pregnancy continuation (66% vs. 94%; P < 0.02) or prenatal treatment (19% vs. 64%; P < 0.001) was less likely. Of 16 CHD cases with pregnancy continuation, beta-inotropic treatment of fetal bradycardia was attempted in three cases: all had left isomerism and died early postnatally. Livebirth and 1-year survival rates of CAVB with CHD were 56% and 19%, respectively, when compared to isolated CAVB with 88% and 75%, respectively (P < 0.0001). The four neonatal survivors (one left isomerism, three cc-TGA) had heart rates persistently > 60 bpm throughout gestation and 3/4 underwent a biventricular repair. CONCLUSIONS: Fetal CAVB with CHD continues to be associated with a poor outcome, in particular in the presence of left isomerism and fetal heart rates < 60 bpm.
Authors:
E T Jaeggi; L K Hornberger; J F Smallhorn; J-C Fouron
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Publication Detail:
Type:  Journal Article; Multicenter Study; Review    
Journal Detail:
Title:  Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology     Volume:  26     ISSN:  0960-7692     ISO Abbreviation:  Ultrasound Obstet Gynecol     Publication Date:  2005 Jul 
Date Detail:
Created Date:  2005-06-28     Completed Date:  2005-11-01     Revised Date:  2005-11-16    
Medline Journal Info:
Nlm Unique ID:  9108340     Medline TA:  Ultrasound Obstet Gynecol     Country:  England    
Other Details:
Languages:  eng     Pagination:  16-21     Citation Subset:  IM    
Copyright Information:
Copyright (c) 2005 ISUOG.
Affiliation:
Unit of Fetal Cardiology, Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Canada. edgar.jaeggi@sickkids.ca
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MeSH Terms
Descriptor/Qualifier:
Echocardiography / methods*
Echocardiography, Doppler / methods
Female
Heart Block / congenital*,  mortality,  ultrasonography
Humans
Hydrops Fetalis / complications,  ultrasonography
Pregnancy
Pregnancy Outcome
Prognosis
Retrospective Studies
Survival Rate
Transposition of Great Vessels / complications,  mortality,  ultrasonography*
Ultrasonography, Prenatal / methods*
Comments/Corrections
Comment In:
Ultrasound Obstet Gynecol. 2005 Jul;26(1):2-3   [PMID:  15971280 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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