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First‐trimester fetal heart block: a marker for cardiac anomaly
Author(s) -
Baschat A. A.,
Gembruch U.,
Knöpfle G.,
Hansmann M.
Publication year - 1999
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 - 10.1046/j.1469-0705.1999.14050311.x
Subject(s) - medicine , cardiology , dextrocardia , fetal echocardiography , heart block , heart disease , great arteries , hypoplastic left heart syndrome , fetus , prenatal diagnosis , electrocardiography , pregnancy , biology , genetics
Background Fetal heart block in the second and third trimesters may be caused by transplacental passage of auto‐antibodies or cardiac defects. Little is known about the etiology of first‐trimester fetal heart block. Materials and methods Fetal heart block was diagnosed in four patients (negative antibody serology) referred for first‐trimester sonographic evaluation of increased fetal nuchal fold thickness with bradycardia. Two‐dimensional echocardiography was complemented by color Doppler flow imaging of the fetal heart. Fetal arrhythmia was verified by M‐mode, pulsed wave Doppler and/or color M‐mode echocardiography. Results All fetuses had congenital heart disease, atrio‐ventricular valve regurgitation, heart block and edema. Autopsy confirmed heterotaxy in three cases (left atrial isomerism with atrial septal defect; left isomerism with double‐outlet right ventricle, great artery malposition and ventricular septal defect. The third case had dextrocardia with atrioventricular canal defect and the fourth case dextrocardia with great artery transposition. Conclusion First‐trimester fetal bradycardia may result from heart block of the type associated with complex congenital heart disease. Accelerated edema formation in this setting may be the basis of nuchal edema formation. First‐trimester fetal echocardiography offers the potential for early diagnosis and intervention in these cases with poor prognosis. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology