Rosenthal D, Druzin M, Chin C, Dubin A
Department of Pediatric Cardiology, Stanford University Medical School, California 94304, USA.
Obstet Gynecol. 1998 Oct;92(4 Pt 2):689-91. doi: 10.1016/s0029-7844(98)00149-5.
Therapy of established congenital complete heart block in the fetus has resulted in improved survival but persistence of heart block. This exposes the infant to the morbidity of heart block, including the risk of sudden death and pacemaker implantation.
A 35-year-old gravida 2, para 1, with Sjogren syndrome and a previous pregnancy complicated by congenital complete heart block presented during her second pregnancy. Intensive fetal monitoring with echocardiography was employed. Early evidence of myocardial dysfunction and dysrhythmia was found, dexamethasone therapy was initiated, and the dysfunction and dysrhythmia resolved. The pregnancy went to term without further complication.
This represents a new and successful strategy to identify very early signs of myocardial disease in a fetus at high risk of congenital complete heart block, enabling targeted, preemptive therapy.
胎儿先天性完全性心脏传导阻滞的现有治疗方法已提高了生存率，但心脏传导阻滞仍持续存在。这使婴儿面临心脏传导阻滞的发病风险，包括猝死和植入起搏器的风险。
一名35岁孕妇，孕2产1，患有干燥综合征，前次妊娠合并先天性完全性心脏传导阻滞，此次妊娠期间前来就诊。采用超声心动图进行强化胎儿监测。发现了心肌功能障碍和心律失常的早期迹象，开始使用地塞米松治疗，功能障碍和心律失常得到缓解。妊娠足月，无进一步并发症。
这代表了一种新的成功策略，可在先天性完全性心脏传导阻滞高危胎儿中识别心肌疾病的极早期迹象，从而实现有针对性的预防性治疗。
