Our clinical report describes a rare finding of a prenatally-detected congenital atrioventricular (AVB) block without associated maternal antibodies, which progressed from 1st/2nd degree AVB to complete heart block during second half of pregnancy. Obstetrical ultrasound at 12th week did not reveal any abnormalities and prenatal echocardiography (due to VSD in afamily member) at the 18th week of gestation detected 1st degree block, then bigeminy and bradycardia. Transplacental treatment with B-2-mimetics was introduced. The delivery was organized in a tertiary center and a pacemaker for the newborn baby was secured and implanted in 15th day of life. Currently the boy`s condition is good and stable. Before therapy with B-2-mimetics the mother underwent echocardiography and ECG which revealed clinically silent structural and conduction heart abnormalities. Literature findings suggest that parents of children with non-immune congenital or childhood AVB are more likely to carry clinically silent conduction abnormalities than general population. Given the corresponding findings in the mother and her son, they should be good candidates for genetic testing.
Among congenital heart defects of the cardiovascular system, patent ductus arteriosus (PDA) comprises about 10% in the general population. Prematurity significantly raises the likelihood of PDA: in preemies of very low birth weight this defect appears with a frequency up to 65%, and in extremely low birth weight preemies up to 80%. Over a span of many years of research many different methods for treating PDA have been discovered, modified, and improved. Invasive treatment (thoracotomy, thoracoscopy, and percutaneous closure) as well as therapeutic strategies (symptomatic treatment, pharmacological treatment) allow for complete closure of PDA in every patient. The limitations of particular methods in regard to age and body mass of the child, their clini cal state, as well as the morphology of the PDA itself, require careful analysis when choosing the appropriate treatment method based on the effectiveness and permanency of closing the duct as well as minimal invasive ness. Among preemies and newborns it is possible to close the PDA using symptomatic and pharmacological treatment as well as through thoracotomy and thoracoscopy, while in older children and adults the method of choice is the percutaneous closure of PDA. Matching the correct treatment strategy with the clinical situation is key to the successful closure of the duct. Presented in the text below is an overview of available methods and their usefulness in treating PDA.
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