Wang Xin, Liu Xiao-Wei, Han Ling, Li Meng-Tao, Zhao Jiu-Liang, Sun Lin, Han Jian-Cheng, Zeng Xiao-Feng, Tian Xin-Ping, Zhao Ying, He Yi-Hua
Echocardiography Medical Center, Maternal-Fetal Medicine Center in Fetal Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Department of Pediatric Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Front Pediatr. 2022 Jul 28;10:904138. doi: 10.3389/fped.2022.904138. eCollection 2022.
To analyze the clinical characteristics, echocardiographic features, and prognosis of fetuses based on three groups of cardiac manifestations associated with maternal anti-Ro and anti-La antibodies in China. This study included three groups: the isolated-arrhythmia, isolated-endocardial fibroelastosis (EFE), and mixed groups.
We prospectively evaluated 36 fetuses with cardiac manifestations due to maternal anti-Ro and anti-La antibodies from our center between 2016 and 2020 in China. Clinical and echocardiographic data were collected.
There were 13 patients (36%) in the isolated-arrhythmia group, eight (22%) in the isolated-EFE group, and 15 (42%) in the mixed group. All patients in the isolated-EFE group presented with mild EFE. Severe EFE was identified in four patients (27%) in the mixed group. Atrioventricular block (AVB) was more common in the isolated-arrhythmia group (13, 100%) than in the mixed group (6, 40%; = 0.001). Moderate-severe mitral regurgitation ( = 0.006), dilated cardiomyopathy (DCM, = 0.017), and low cardiovascular profile scores ( = 0.013) were more common in the mixed group than in the other two groups. Twenty-one mothers decided to terminate the pregnancy and 15 fetuses were born with regular perinatal treatment. They all survived at 1 year of age. One patient in the isolated-arrhythmia group and two in the mixed group required a pacemaker due to third-degree AVB or atrioventricular junctional rhythm. Five patients in the isolated-EFE group and five in the mixed group had no DCM or heart failure and the location of mild EFE was significantly reduced.
Fetal cardiac manifestations due to maternal anti-Ro and anti-La antibodies can be divided into three groups, i.e., the isolated-arrhythmia, isolated-EFE, and mixed groups. AVB usually occurs in the isolated-arrhythmia group. Severe EFE, moderate-severe mitral regurgitation, and DCM mainly appear in the mixed group. Location of mild EFE significantly reduces after birth and the outcome of fetuses with mild EFE depends on the presence of arrhythmia and its subtypes.
基于中国与母体抗Ro和抗La抗体相关的三组心脏表现，分析胎儿的临床特征、超声心动图特征及预后。本研究包括三组：孤立性心律失常组、孤立性心内膜弹力纤维增生症（EFE）组和混合组。
我们前瞻性评估了2016年至2020年期间在中国本中心的36例因母体抗Ro和抗La抗体而出现心脏表现的胎儿。收集了临床和超声心动图数据。
孤立性心律失常组有13例患者（36%），孤立性EFE组有8例（22%），混合组有15例（42%）。孤立性EFE组的所有患者均表现为轻度EFE。混合组中有4例患者（27%）被诊断为重度EFE。房室传导阻滞（AVB）在孤立性心律失常组（13例，100%）中比在混合组（6例，40%；P = 0.001）中更常见。中度至重度二尖瓣反流（P = 0.006）、扩张型心肌病（DCM，P = 0.017）和低心血管轮廓评分（P = 0.013）在混合组中比在其他两组中更常见。21位母亲决定终止妊娠，15例胎儿在接受常规围产期治疗后出生。他们在1岁时均存活。孤立性心律失常组有1例患者，混合组有2例患者因三度AVB或房室交界性心律需要起搏器。孤立性EFE组有5例患者，混合组有5例患者没有DCM或心力衰竭，轻度EFE的范围明显缩小。
因母体抗Ro和抗La抗体导致的胎儿心脏表现可分为三组，即孤立性心律失常组、孤立性EFE组和混合组。AVB通常发生在孤立性心律失常组。重度EFE、中度至重度二尖瓣反流和DCM主要出现在混合组。轻度EFE在出生后范围明显缩小，轻度EFE胎儿的预后取决于心律失常的存在及其亚型。
