COMPLETE ATRIOVENTRICULAR HEART-BLOCK - P RENATAL-DIAGNOSIS AND PERINATAL MANAGEMENT

Objective. To describe our experience in prenatal diagnosis and perina tal management of congenital atrioventricular heart block, as well as pacemaker treatment in the neonate. Material and methods. A total of 1 3 fetuses are included. The diagnosis of atrioventricular dissociation was established by Doppler heart rate sample in the right atrium to s how the atrial activity while the sample in the aorta reflected the ve ntricular heart rate. Gestational age at diagnosis, ventricular heart rates, autoimmune maternal pathology, maternal blood tests for autoant ibodies antiRo+, congenital structural heart disease, fetal hydrops, m aternal medical treatment, perinatal results and pacemaker neonatal im plantation are described. Results. Gestational age at diagnosis ranged between 22 and 32 (mean 27,6) weeks. Ventricular heart rates ranged b etween 32 to 80 (mean 54) beats/min. AntiRo+ antibodies were detected in 5 mothers, and clinical systemic lupus erythematosns was found in o nly one. Pour had congenital heart disease (2 ventricular inversion an d corrected TGA, 1 complete atrio-ventricular canal and 1 tricuspid at resia). Signs of heart failure and hydrops were detected in 9 fetuses. Treatment with beta-metasona and ritodrine was administered to 7 moth ers when the ventricular heart rate dropped below 60 beats/min. Intrau terine fetal death occurred in 3 fetuses with structural congenital he art disease and hydrops. Delivery was performed by cesarean section in 8 preterm fetuses (one them a twins), 3 spontaneous deliveries at ter m and 3 stillbirth. Postnatal pacemarker implantation was carried out in 9 newborns (3 cases with unicameral temporal right ventricle electr ode and 6 cases with permanent bicameral electrodes implanted through the subclavian vein and DDD pacemaker). Follow-up of the bicameral pac emaker group was satisfactory. Conclusion. Persistent fetal bradycardi a is the first sign to diagnose prenatal complete atrioventricular hea rt block. Echocardiography asses fetal haemodynamic status and may det ect signs of fetal deterioration. Hydrops and further drop In the vent ricular heart rate warrant urgent cesarean section and pacemaker manag ement of the newborn.