Fetal treatment of congenital heart block ascribed to anti-SSA antibody: Case reports with observation of cardiohemodynamics and review of the literature

PROBLEM: Maternal anti-SSA(B) antibody crosses the placenta and causes feta l myocarditis, congenital heart block (CHB), hydrops fetalis, and intrauter ine fetal death. The aim of this study was to evaluate corticosteroids' eff icacy as a treatment for CHB. METHOD OF STUDY: One fetus with complete CHB and one fetus with incomplete CHB due to anti-SSA(B) antibody received maternal prednisolone (PSL) and de xamethasone (DEXA) treatments. Heart rate, cardiothoracic ratio (CTR), left ventricular fractional shortening (FS), and preload index (PLI) were longi tudinally measured by serial fetal echocardiograms. RESULTS: In the former case, after maternal PSL/DEXA administration,improve ment of cardiohemodynamics, i.e., the reduction of PLI from 1.7 to 0.4, CTR from 70 to 52%, and FS from 63 to 54% were observed. In the latter case, s econd degree 2:1 block was converted to 3:2 block/sinus rhythm, resulting i n the increase of the fetal heart rate from 65 to 116 beats per minute (bpm ). CONCLUSIONS: We disclosed for the first time the beneficial effects of cort icosteroids in the fetal cardiohemodynamics and conduction system of affect ed fetuses with the presence of maternal anti-SSA(B) antibodies.