SUMMARY In a series of over 6000 patients referred for fetal echocardiography during an eight year period, 37 fetuses were found to have complete heart block. There were 16 cases of isolated heart block and 21 cases associated with structural heart disease. All mothers of fetuses with isolated complete heart block had evidence of circulating syndrome Sjogren A antibody (Ro). Only one mother had clinical evidence of connective tissue disease. In the 21 cases associated with structural heart disease there were 17 cases of atrioventricular septal defect, one case of secundum atrial and perimembranous ventricular septal defects, two cases of tetralogy of Fallot, and one case ofpulmonary stenosis. All fetuses with atrioventricular septal defects and complete heart block had left atrial isomerism. Additional abnormalities of the great arteries were often found in this group; these were double outlet right ventricle, transposition of the great arteries, pulmonary atresia, coarctation of aorta, and stenosis of the pulmonary or aortic valves. Intrauterine congestive heart failure was a feature of four cases in the group with isolated complete heart block and 1 1 cases of the group with associated structural heart disease. The outcome in the fetuses with isolated complete heart block was better than in those with heart disease: 12 of the 16 fetuses are alive, two of them have a pacemaker. But only three ofthe group of21 fetuses with cardiac malformation are alive, and two of them have a pacemaker.Complete heart block was first described as "impaired atrioventricular syndrome" by Morquio in 1901.' The condition was characterised by a slow pulse, syncopal attacks, and sudden death. Since then many workers have reported cases of isolated complete heart block and its association with structural heart lesions.' Hull et al in 1966 recognised the relation between maternal systemic lupus erythematosus and complete heart block; they described a child born to a mother with active lupus.' More recently a strong association has been found between isolated infantile complete heart block and the presence of syndrome Sjogren A antibody in maternal serum.67 This antibody is also known as Ro, after the patient in whom it was first detected.8The first case of fetal heart block was reported by Plant and Steven in 1945.9 The diagnosis was suspected by fetal heart auscultation and fetal electrocardiogram. Fetal heart block can now be detected by M mode and Doppler echocardiographic examinRequests for reprints to Dr
SUMMARY In a series of more than 3500 pregnancies referred for fetal echocardiography, 29 cases ofatrioventricular septal defect were detected in the fetus. There was a chromosomal anomaly in 14 of these cases, left atrial isomerism in 12, and right atrial isomerism in two. Complete heart block was found in 11 of the cases with left atrial isomerism. Many associated cardiac abnormalities were found, particularly in the fetuses with atrial isomerism; the most common were double outlet right ventricle or aortic arch anomalies.
SUMMARY The time to peak velocity was measured by Doppler echocardiography in the pulmonary artery in 102 normal human fetuses (gestational age 16-30 weeks). Time to peak velocity in the aorta was measured in 72. In 58 both measurements could be made in the same fetus. The time to peak velocity was shorter in the pulmonary artery than in the aorta. This difference was statistically significant. This suggests that in the midtrimester fetus mean pressure in the pulmonary artery is higher than in the aorta.Cross sectional echocardiographic examination of the normal fetal heart has become well established in recent years.1 -The intracardiac structures can be readily identified and the Doppler sample volume accurately positioned to allow the characteristics of the blood flow velocity waveform through each cardiac valve to be evaluated.4The prediction of pulmonary artery pressure by non-invasive methods in children and adults has been reported recently. Studies using Doppler echocardiography in pulmonary hypertension have shown a good correlation between the acceleration time and the mean pressure measured by cardiac catheterisation.5 6 As pulmonary artery pressure increased the time from the onset of ejection to peak velocity became shorter.We compared the acceleration time in the pulmonary artery and aorta in a series of normal fetuses to assess the relative mean arterial pressures in fetal life. Patients and methodsOne hundred and two pregnant women were selected for fetal echocardiographic examination between 16 and 30 weeks' gestation. The study group were referred to us because of a previous family history of congenital heart disease or they came as volunteers from the routine antenatal clinic. All the Requests for reprints to
Congenital heart disease (CHD) is the most common birth defect and the leading cause of mortality in the first year of life. In fetuses with a heart defect, chromosomal abnormalities are very frequent. Besides aneuploidy, 22q11.2 deletion is one of the most recognizable chromosomal abnormalities causing CHD. The frequency of this abnormality varies in nonselected populations. This study aimed to investigate the incidence of the 22q11.2 deletion and other chromosomal alterations in a Brazilian sample of fetuses with structural cardiac anomalies detected by fetal echocardiography. In a prospective study, 68 fetuses with a heart defect were evaluated. Prenatal detection of cardiac abnormalities led to identification of aneuploidy or structural chromosomal anomaly in 35.3% of these cases. None of the fetuses with apparently normal karyotypes had a 22q11.2 deletion. The heart defects most frequently associated with chromosomal abnormalities were atrioventricular septal defect (AVSD), ventricular septal defect (VSD), and tetralogy of Fallot. Autosomal trisomies 18 and 21 were the most common chromosomal abnormalities. The study results support the strong association of chromosome alterations and cardiac malformation, especially in AVSD and VSD, for which a chromosome investigation is indicated. In fetuses with an isolated conotruncal cardiopathy, fluorescence in situ hybridization (FISH) to investigate a 22q11.2 deletion is not indicated.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.