Cuneo Bettina F
The Heart Institute for Children, Department of Pediatrics, Rush Medical College, and Hope Children's Hospital, 440 W. 95th Street, Oak Lawn, IL 60453, USA.
Curr Opin Pediatr. 2006 Oct;18(5):490-6. doi: 10.1097/01.mop.0000245348.52960.11.
The present review summarizes the prenatal and postnatal outcome of cardiac anomalies and sustained arrhythmias diagnosed during fetal life.
The outcome of sustained fetal arrhythmias has improved with greater experience using Sotalol for atrial flutter, and digoxin and amiodarone for 1: 1 reciprocating tachycardia. The outcome of fetal conduction system disease secondary to maternal Sjögren's antibodies has noticeably improved with transplacental dexamethasone. The postnatal prognosis for atrioventricular block associated with left atrial isomerism, however, remains very bleak. Assessing the effect of prenatal diagnosis on the outcome of structural defects remains difficult because of the high number of extracardiac anomalies and chromosome defects in this group. Preoperative survival is improved, but postoperative mortality has not improved. One clear advantage of prenatal diagnosis is the selection of fetuses that may benefit from in-utero intervention to limit the progression of their disease or lessen its severity at birth.
For the most part, postoperative mortality of structural cardiac defects is not significantly improved by prenatal diagnosis. In-utero management of tachyarrhythmias and conduction system disease has improved postnatal outcome, except for the fetus with atrioventricular block and left atrial isomerism.
本综述总结了胎儿期诊断出的心脏异常和持续性心律失常的产前及产后结局。
随着在使用索他洛尔治疗心房扑动、地高辛和胺碘酮治疗1:1折返性心动过速方面经验的增加，持续性胎儿心律失常的结局有所改善。经胎盘给予地塞米松后，继发于母亲干燥综合征抗体的胎儿传导系统疾病的结局有显著改善。然而，与左房异构相关的房室传导阻滞的产后预后仍然非常严峻。由于该组中心脏外异常和染色体缺陷数量众多，评估产前诊断对结构缺陷结局的影响仍然困难。术前生存率有所提高，但术后死亡率并未改善。产前诊断的一个明显优势是可以选择可能从宫内干预中受益的胎儿，以限制疾病进展或减轻其出生时的严重程度。
在很大程度上，产前诊断并未显著改善结构性心脏缺陷的术后死亡率。除了患有房室传导阻滞和左房异构的胎儿外，胎儿快速心律失常和传导系统疾病的宫内管理改善了产后结局。
