A Case of Prenatal Diagnosis of Congenital Total AV Block on VSD and PDA with Ultrasound

Yusrawati Yusrawati(1*), Nanda Tri Wahdini(2), Hauda El Rasyid(3), Muhammad Riendra(4)

(1) Obstetrics and Gynecology Department, Faculty of Medicine, Andalas University, Padang, West Sumatera
(2) Obstetrics and Gynecology Departement, Faculty of Medicine Andalas University Padang
(3) Arrhythmia Division of Cardiology Department, Faculty of Medicine Andalas University, Padang
(4) Cardiothoracic Division of Surgery Department, Faculty of Medicine Andalas University, Padang
(*) Corresponding Author

DOI: https://doi.org/10.25077/aoj.5.2.244-253.2021

Abstract


Objective : To report the diagnosis and management of congenital total AV block on VSD and PDA in pregnancy.

Method : A case report

Case : A 37-year-old multiparous woman G4P3A0H2 24- 25 weeks of preterm pregnancy with fetal bradycardia, VSD, PDA with ultrasonography and CTG results was FHR 70 bpm. At 37- 38 weeks of pregnancy, termination of pregnancy was performed by cesarean delivery with preparation for complication of fetal AV block. A male baby was born with weight 2600 gram and APGAR score of 8/9. Immediate echocardiography result was situs solitus, VSD PM LR shunt, PDA LR shunt, good left ventricular function, left aortic arch and EF 74%. ECG result was sinus bradycardia, total AV block with junctional escape rhythm. Sternotomy and PPM implantation was performed by cardiothoracic surgeon three hours after the baby was born. Post PPM implantation, ECG results was HR 165 bpm and chest X- rays interpretation was cardiomegaly with plethora. Mother and baby came home in good condition on the 6th day of treatment. On the next baby’s control at 4.5 months obtained a weight of 5.4 kg with the echocardiography results was solitus, VSD PM LàR shunt, VSD muscular multiple 3 pieces LàR shunt, PDA LàR shunt, good right and left ventricular function, and left arch. The child got captopril 2x1.5 mg and planned for a 6-month repeat echocardiography.

Conclusion : Congenital of total AV block on VSD and PDA is confirmed by prenatal diagnosis and preparation for comprehensive multidisciplinary management.

Keywords: congenital total AV block, fetal bradycardia, fetal echocardiography, PPM, ultrasound


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References


Benjamin PS, Craig VT. Fetal Bradycardia in Response to Maternal Hypothermia.

American College of Obstetricians and Gynecologists. 2020;135:1454-1456.

Carvalho JS. Primary bradycardia : keys and pitfalls in diagnosis. Ultrasound Obstetri Gynecology. 2014;44:125-130.

Mok CW, Park JY, Kim K, et al. Fetal Congenital Complete Atrioventricular Block in a Mother with Isolated Serum Anti-SSA/Ro and Anti-SSB/La Antibodies. Perinatology. 2016;27:185-189.

Nava-Rivera LE, Lozoya-Martinez R, Chi-Arguelles D, Moran-Martinez J. Permanent pacemaker implantation in complete congenital fetal atrioventricular (AV): a case report. Revista Mexicana de Cardiología. 2018;29:50-54.

Ambrosi A, Wahren-Herlenius M. Congenital heart block: evidence for a pathogenic role of maternal autoantibodies. Arthritis Res Ther. 2012;14:208.

Bettina FC, Sven-Erik S, Stephanie L, al e. Home Monitoring for Fetal Heart Rhythm During Anti-Ro Pregnancies. Journal of the American College of Cardiology. 2018;72:1940-1951.

Lee JY, Hur SE, Lee SK. Prevention of anti-SSA/Ro and anti-SSB/La antibodies- mediated congenital heart block in pregnant woman with systemic lupus erythematosus: A case report. Korean J Obstet Gynecol. 2012;55:502-506.

Friedman DM, Kim MY, Copel JA, Llanos C, Davis C, Buyon JP. Prospective evaluation of fetuses with autoimmune-associated congenital heart block followed in the PR Interval and Dexamethasone Evaluation (PRIDE) Study. Am J Cardiol. 2009;103:1102-1106.

Donofrio MT, Moon-Grady AJ, Hornerger LK, Copel JA. Diagnosis and Treatment of Fetal Cardiac Disease: A Scientific Statement From the American Heart Association. Circulation. 2014;129:2183-2242.

Buyon JP, Hiebert R, Copel JA, Craft J. Autoimmune-associated congenital heart block: demographics, mortality, morbidity and recurrence rates obtained from a national neonatal lupus registry. J Am Coll Cardiol. 1998;31:1658-1666.

Brito-Zeron P, Izmirly P, Ramos-Casals M, Buyon JP. Autoimmune congenital heart block: complex and unusual situations. Lupus. 2016;25:116-128.

Dey M, Jose T, Shrivastava A, Wadhwa RD, Agarwal R, Nair V. Complete congenital foetal heart block: a case report. Facts, Views & Vision in ObGyn. 2014;6:39.

Lianos C, Friedman DM, Izmirly P, Tseng CE. Anatomical and pathological findings in hearts from fetuses and infants with cardiac manifestations of neonatal lupus. Rheumatology. 2012;51:1086-1092.

Chandler SF, Fynn-Thompson F, Mah DY. Role of cardiac pacing in congenital complete heart block. Expert review of cardiovascular therapy. 2017;15:853-861.

Capone C, J.P, Friedman DM, Frishman WH. CardiaC manifestations of neonatal lupus: a review of autoantibody-associated congenital heart block and its impact in an adult population. Cardiol Rev. 2011;20:72-76.


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