MANAGEMENT WITH A STAGED APPROACH OF THE PREMATURE HYDROPIC FETUS DUETO COMPLETE CONGENITAL HEART-BLOCK

The management of the preterm fetus with hydrops due to complete conge nital heart block is difficult. The outcome is frequently associated w ith 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 adopte d: (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 ventilat ion, drainage of all cavities with effusions; (4) increase neonatal he art rate by administration of TV isoprenaline, by bipolar trans-oesoph ageal pacing or epicutaneo-oesophageal pacing; (5) after the regressio n 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 pati ents a permanent pacing system was implanted at the ages of 8 weeks (2 045 g) and 4 weeks (1560 g) respectively. No major complications occur red; the cardiac outcome with 37 and 34 months of follow up is excelle nt. Conclusion This proposed staged approach with temporary epicardial leads can improve the outcome of hydropic fetuses due to complete con genital AV block.