Transplacental fetal treatment improves the outcome of prenatally diagnosed complete atrioventricular block without structural heart disease

Article

关键词: NEONATAL LUPUS;    LA ANTIBODIES;    ANTI-RO;    THERAPY;    MYOCARDITIS;    EXPERIENCE;    CHILDREN;    FETUS;    CARDIOMYOPATHY;    PACEMAKERS;   

DOI  :  10.1161/01.CIR.0000142046.58632.3A

来源: SCIE

【 摘 要 】

Background - Untreated isolated fetal complete atrioventricular block ( CAVB) has a significant mortality rate. A standardized treatment approach, including maternal dexamethasone at CAVB diagnosis and beta-stimulation for fetal heart rates < 55 bpm, has been used at our institutions since 1997. The study presents the impact of this approach. Methods and Results - Thirty-seven consecutive cases of fetal CAVB since 1990 were studied. Mean age at diagnosis was 25.6 +/- 5.2 gestational weeks. In 33 patients (92%), CAVB was associated with maternal anti-Ro/La autoantibodies. Patients were separated into those diagnosed between 1990 and 1996 ( group 1; n = 16) and those diagnosed between 1997 and 2003 ( group 2; n = 21). The 2 study groups were comparable in the clinical presentation at CAVB diagnosis but did differ in prenatal management ( treated patients: group 1, 4/16; group 2, 18/21; P < 0.0001). Overall, 22 fetuses were treated, 21 with dexamethasone and 9 with beta-stimulation for a mean of 7.5 +/- 4.5 weeks. Live-birth and 1-year survival rates of group 1 were 80% and 47%, and these improved to 95% for group 2 patients ( P < 0.01). The 21 patients treated with dexamethasone had a 1-year survival rate of 90%, compared with 46% without glucocorticoid therapy ( P < 0.02). Immune-mediated conditions ( myocarditis, hepatitis, cardiomyopathy) resulting in postnatal death or heart transplantation were significantly more common in untreated anti- Ro/La antibody - associated pregnancies compared with patients treated with steroids (0/18 versus 4/9 live births; P = 0.007). Conclusions - A standardized treatment approach, including transplacental fetal administration of dexamethasone and beta-stimulation at heart rates <55 bpm, reduced the morbidity and improved the outcome of isolated fetal CAVB.

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