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Prenatal diagnosis of complete atrioventricular block associated with structural heart disease: combined experience of two tertiary care centers and review of the literature
Author(s) -
Jaeggi E. T.,
Hornberger L. K.,
Smallhorn J. F.,
Fouron J.C.
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.1919
Subject(s) - medicine , atrioventricular block , great arteries , fetus , heart disease , pregnancy , heart block , prenatal diagnosis , hydrops fetalis , retrospective cohort study , cardiology , pediatrics , obstetrics , surgery , electrocardiography , biology , genetics
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, β‐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. Copyright © 2005 ISUOG. Published by John Wiley & Sons, Ltd.