Deloof E, Devlieger H, Van Hoestenberghe R, Van den berghe K, Daenen W, Gewillig M
Department of Cardiac Surgery, University Hospital Gasthiusberg, Leuven, Belgium.
Eur J Pediatr. 1997 Jul;156(7):521-3. doi: 10.1007/s004310050652.
The management of the preterm fetus with hydrops due to complete congenital heart block is difficult. The outcome is frequently associated with significant morbidity and mortality. Two fetuses presented at the post menstrual age of 29 and 30 weeks respectively with severe hydrops due to complete heart block. The following staged approach was adopted: (1) enhance fetal lung maturation with maternal corticosteroids and thyroid releasing hormone for 48 h; (2) elective Caesarean section; (3) classical neonatal management consisting of intubation and ventilation, drainage of all cavities with effusions; (4) increase neonatal heart rate by administration of i.v. isoprenaline, by bipolar trans-oesophageal pacing or epicutaneo-oesophageal pacing; (5) after the regression of the hydrops, start epicardial pacing after implantation of 2 or 3 temporary epicardial 3/0 pacemaker; (6) implantation of a permanent abdominal pacing system with steroid epicardial tip once the threshold exceeds 20 mA or when the baby weighs more than 1500 g. In these patients a permanent pacing system was implanted at the ages of 8 weeks (2045 g) and 4 weeks (1560 g) respectively. No major complications occurred; the cardiac outcome with 37 and 34 months of follow up is excellent.
This proposed staged approach with temporary epicardial leads can improve the outcome of hydropic fetuses due to complete congenital AV block.
对于因完全性先天性心脏传导阻滞而出现水肿的早产胎儿，其管理颇具难度。结局往往伴随着显著的发病率和死亡率。两名分别在孕龄29周和30周时因完全性心脏传导阻滞出现严重水肿的胎儿。采取了以下分阶段方法：（1）使用母体皮质类固醇和促甲状腺激素释放激素促进胎儿肺成熟48小时；（2）择期剖宫产；（3）经典的新生儿管理，包括插管和通气、引流所有有积液的腔隙；（4）通过静脉注射异丙肾上腺素、双极经食管起搏或经皮食管起搏提高新生儿心率；（5）水肿消退后，在植入2或3根临时心外膜3/0起搏器后开始心外膜起搏；（6）一旦阈值超过20毫安或婴儿体重超过1500克，植入带有类固醇心外膜尖端的永久性腹部起搏系统。在这些患者中，分别在8周龄（2045克）和4周龄（1560克）时植入了永久性起搏系统。未发生重大并发症；随访37个月和34个月时心脏结局良好。
这种采用临时心外膜导联的分阶段方法可改善因完全性先天性房室传导阻滞导致水肿的胎儿的结局。
