Hoda Mehar, Scott William, Sharma Kavita, Duryea Elaine, Ikemba Catherine
Division of Pediatric Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center, 1935 Medical District Dr, Dallas, TX, 75235, USA.
Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, USA.
Pediatr Cardiol. 2023 Mar;44(3):727-731. doi: 10.1007/s00246-022-02945-6. Epub 2022 Jun 14.
Maternal autoantibody-related complete heart block in the fetus is considered irreversible. During prenatal care for a 25-year-old nulliparous Hispanic woman with newly diagnosed nephrotic-range proteinuria and positive anti-nuclear antigen antibody, complete fetal heart block with a ventricular rate of 60 beats per minute was detected on a fetal echocardiogram at 28-week gestation. A small pericardial effusion and ascites were noted consistent with fetal hydrops. Dexamethasone and hydroxychloroquine were initiated. Fetal rhythm improved to Mobitz type 1 second-degree heart block, with a ventricular rate of 91 beats per minute. The fetus was born prematurely at 34-week gestation with second-degree heart block which improved to first-degree heart block prior to hospital discharge. First-degree heart block persisted at 2 years of age with a P-R interval of 185 ms. Transplacental treatment with dexamethasone and hydroxychloroquine was associated with sustained reversal of complete heart block to sinus rhythm.
胎儿的母体自身抗体相关完全性心脏传导阻滞被认为是不可逆的。在对一名25岁初产西班牙裔妇女进行产前检查时，该妇女新诊断为肾病范围蛋白尿且抗核抗原抗体呈阳性，在妊娠28周时通过胎儿超声心动图检测到胎儿完全性心脏传导阻滞，心室率为每分钟60次。发现有少量心包积液和腹水，符合胎儿水肿。开始使用地塞米松和羟氯喹。胎儿心律改善为莫氏Ⅰ型二度心脏传导阻滞，心室率为每分钟91次。胎儿在妊娠34周时早产，患有二度心脏传导阻滞，在出院前改善为一度心脏传导阻滞。在2岁时一度心脏传导阻滞持续存在，P-R间期为185毫秒。地塞米松和羟氯喹的经胎盘治疗与完全性心脏传导阻滞持续逆转至窦性心律有关。
