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Atrioventricular block detected in fetal life: associated anomalies and potential prognostic markers
Author(s) -
Berg C.,
Geipel A.,
Kohl T.,
Breuer J.,
Germer U.,
Krapp M.,
Baschat A. A.,
Hansmann M.,
Gembruch U.
Publication year - 2005
Publication title -
ultrasound in obstetrics and gynecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.202
H-Index - 141
eISSN - 1469-0705
pISSN - 0960-7692
DOI - 10.1002/uog.1918
Subject(s) - medicine , fetus , atrioventricular block , pregnancy , hydrops fetalis , fetal echocardiography , cardiology , heart block , heart failure , prenatal diagnosis , obstetrics , electrocardiography , genetics , biology
Objectives To assess the spectrum of anomalies associated with fetal heart block and to identify possible prognostic markers. Methods Retrospective review of all cases of second‐ or third‐degree heart block identified in two tertiary referral centers in Germany (Bonn and Lübeck) and one in the USA (Baltimore). Results Sixty fetuses with heart block were identified in the study period. Thirty‐two had complex cardiac malformations, 31 of them associated with left isomerism. The outcomes of these fetuses were 22 terminations of pregnancy (TOP), three intrauterine fetal deaths (IUFD), three neonatal deaths (NND), two childhood deaths (CD) and there were two survivors. In 20 cases without complex cardiac malformations maternal antinuclear‐antibodies were detected. Their outcomes were 2 TOP, 1 IUFD, 1 NND and 16 survived. The remaining eight cases had neither complex cardiac malformations nor associated maternal antibodies. Their outcomes were 1 TOP, 2 IUFD, 2 NND and 3 survived. After exclusion of terminated cases, hydrops as well as the presence of cardiac defects was significantly associated with non‐survival ( P < 0.01). The cardiothoracic circumference ratio was significantly higher in hydropic fetuses and significantly negatively correlated with survival in immune‐mediated cases ( P < 0.01). Atrial and ventricular frequencies and their evolution did not accurately predict fetal or neonatal outcome. Sympathomimetic treatment in seven cases was not associated with favorable fetal outcome in cases of hydrops or cardiac malformations. Conclusions The most important marker predicting adverse outcome in cases of heart block is fetal hydrops, followed by the association with complex cardiac malformations. Cases without cardiac malformations have a significantly better prognosis, especially in the absence of severe cardiomegaly. Copyright © 2005 ISUOG. Published by John Wiley & Sons, Ltd.