Congenital complete heart block in the fetus: Hemodynamic features, antenatal treatment, and outcome in six cases

Congenital heart block (CHB) can result in intrauterine cardiac failure lea ding to fetal or neonatal loss. To establish perinatal hemodynamic factors which might predict adverse outcome, six fetuses with CHB diagnosed between 20 and 30 gestational weeks were examined by echocardiography at 2-week in tervals. Neonatal morbidity and outcome in infancy are detailed. The fetuse s showed a significant decrease in ventricular rate (VR) with advancing ges tation (60 +/- 7 vs 51 +/- 4 beats/min, p = 0.03). Cardiac decompensation d efined as hydrops or pericardial effusion was associated with VR of lower t han 55 beats/min in two fetuses. Three mothers had a therapeutic trial with a sympathomimetic and digoxin. Salbutamol increased VR 10% in one of three fetuses treated. Digoxin decreased pericardial effusion in one hydropic fe tus with autoimmune myocarditis. In this fetus, poor left ventricular fract ional shortening (LVFS) was accompanied with high umbilical artery resistan ce index (RI). High amniotic fluid erythropoietin indicated severe hypoxia preceding death. Pacemaker was indicated in all the newborns. At the age of 2 weeks all the surviving infants had tricuspid regurgitation and a shunt through foramen ovale due to asynchronized atrioventricular contraction. Du ring the 12-month follow-up two of five surviving infants had no symptoms. One had Symptomatic neonatal lupus. Two infants had patent ductus arteriosu s, one with dilated cardiomyopathy. In conclusion, poor fetal outcome was a ssociated with low VR, low LVFS, and high RI Despite early pacing, morbidit y was high in infancy due to cardiomyopathy and associated heart defects. R egular echo cardiographic monitoring during pregnancy and after deliver is required in order to optimize care and timing of any interventions.