Prenatal Management Strategy for Immune-Associated Congenital Heart Block in Fetuses

Liao, Hongyu; Tang, Changqing; Qiao, Liang; Zhou, Kaiyu; Hua, Yimin; Li, Yifei

doi:10.3389/fcvm.2021.644122

Cited by 12 publications

(26 citation statements)

References 69 publications

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“…Owing to the lack of control group (untreated group) and limited sample size, it was difficult to prove progression of higher-degree AVB could be prevented by fluorinated steroids and HCQ in our study. As summarized in our recent review ( 23 ), fetal autoimmune-associated first-degree AVB could revert to normal or maintained unchanged without treatment. Indeed, the twin in our study presented with no progression without therapy (as IVIG is not a proven therapy).…”

Section: Discussionmentioning

confidence: 81%

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Case Report: Prenatal Diagnosis and Treatment of Fetal Autoimmune-Associated First-Degree Atrioventricular Block: First Report From China

Tang

Shao

et al. 2021

Front. Cardiovasc. Med.

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Background: The rapid progression from fetal first-degree atrioventricular block (AVB) to third-degree AVB had been reported. However, how to define fetal first-degree AVB with proper technique and the necessity of the treatment in utero for fetal autoimmune-associated first-degree AVB are still controversial.Purpose: To explore the diagnosis and the effect of treatment for fetal first-degree AVB.Cases Presentation: Four pregnant women with positive autoantibodies anti-SSA/Ro were admitted into our hospital with complaints of rapid prolonged atrioventricular (AV) intervals of their fetuses. Fetal AV intervals were re-measured by tissue Doppler imaging (TDI) from the onset of atrial contraction to ventricular systole (Aa-Sa), which were 170 ms (case 1-twin A), 160 ms (case 1-twin B), 163 ms (case 2) and 172 ms (case 3) and 170 ms (case 4), respectively. The histories of medication usage or infection during gestation were denied. Amniotic fluid genetic screenings and virological tests were negative in all cases. No structural cardiac disorders were found and the cardiovascular profile scores were 10 for each fetus. Oral dexamethasone (initial dose of 4.5 mg daily) and hydroxychloroquine (200 mg bid) plus weekly follow-up surveillance were suggested. The dosage of dexamethasone was adjusted according to the changes of the AV intervals and fetal development of biparietal diameters (BPD) and femur lengths (FL). All fetal AV intervals were controlled well. Maternal and fetal adverse effects were noted as diabetes in 1 mother and growth retardation in all fetuses. All fetuses were delivered via cesarean section at 35+4, 37, 38, and 37+1 gestational weeks, with 10 scores of Apgar score. Postnatally, positive anti-SSA/Ro was found in all neonates. However, there were no clinical or laboratory evidence of neonatal lupus syndrome. No abnormal signs were found on postnatal electrocardiogram and echocardiography for all neonates. With a follow-up of 8–53 months, there was no progression of disease and all infants demonstrated normal physical, mental, and motor development.Conclusion: Prenatal treatment for fetal autoimmune-associated first-degree AVB could be an alternative. Strict surveillance and timely adjustment of the treatment according to the conditions of the mother and the fetus are indicated. Further studies are necessary to prove our concept.

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Section: Discussionmentioning

confidence: 81%

“…As summarized in our recent review (23), fetal autoimmuneassociated first-degree AVB could revert to normal or maintained unchanged without treatment. Indeed, the twin in our study presented with no progression without therapy (as IVIG is not a proven therapy).…”

Section: Prenatal Treatmentmentioning

confidence: 84%

Case Report: Prenatal Diagnosis and Treatment of Fetal Autoimmune-Associated First-Degree Atrioventricular Block: First Report From China

Tang

Shao

et al. 2021

Front. Cardiovasc. Med.

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“…Figure 2 shows that congenital heart block and neonatal lupus are highly associated [ 36 ]. Figure 3 shows that fetal congenital heart block is associated with maternal autoimmunity and with lupus [ 37 ].…”

Section: Resultsmentioning

confidence: 99%

Autoimmune Disease Classification Based on PubMed Text Mining

Samuels

Malov

Saha

et al. 2022

JCM

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Autoimmune diseases (AIDs) are often co-associated, and about 25% of patients with one AID tend to develop other comorbid AIDs. Here, we employ the power of datamining to predict the comorbidity of AIDs based on their normalized co-citation in PubMed. First, we validate our technique in a test dataset using earlier-reported comorbidities of seven knowns AIDs. Notably, the prediction correlates well with comorbidity (R = 0.91) and validates our methodology. Then, we predict the association of 100 AIDs and classify them using principal component analysis. Our results are helpful in classifying AIDs into one of the following systems: (1) gastrointestinal, (2) neuronal, (3) eye, (4) cutaneous, (5) musculoskeletal, (6) kidneys and lungs, (7) cardiovascular, (8) hematopoietic, (9) endocrine, and (10) multiple. Our classification agrees with experimentally based taxonomy and ranks AID according to affected systems and gender. Some AIDs are unclassified and do not associate well with other AIDs. Interestingly, Alzheimer’s disease correlates well with other AIDs such as multiple sclerosis. Finally, our results generate a network classification of autoimmune diseases based on PubMed text mining and help map this medical universe. Our results are expected to assist healthcare workers in diagnosing comorbidity in patients with an autoimmune disease, and to help researchers in identifying common genetic, environmental, and autoimmune mechanisms.

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“…The medical care of congenital heart block is currently focused on identifying the optimal timing of pacemaker therapy to ensure a positive outcome. 17,18 Pacemaker implantation may improve long term survival as well as prevent syncopal events among those asymptomatic patients with congenital AVB In those patients diagnosed in utero, management options are limited. Fortunately, slow escape rhythms leading to fetal distress and hydrops is rare, with the majority of patients having an adequate rate to support their hemodynamics through term gestation.…”

Section: Discussionmentioning

confidence: 99%

A Case of Prenatal Diagnosis of Congenital Total AV Block on VSD and PDA with Ultrasound

Yusrawati¹,

Wahdini

Rasyid

et al. 2021

AOJ

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Objective : To report the diagnosis and management of congenital total AV block on VSD and PDA in pregnancy.Method : A case reportCase : A 37-year-old multiparous woman G4P3A0H2 24- 25 weeks of preterm pregnancy with fetal bradycardia, VSD, PDA with ultrasonography and CTG results was FHR 70 bpm. At 37- 38 weeks of pregnancy, termination of pregnancy was performed by cesarean delivery with preparation for complication of fetal AV block. A male baby was born with weight 2600 gram and APGAR score of 8/9. Immediate echocardiography result was situs solitus, VSD PM LR shunt, PDA LR shunt, good left ventricular function, left aortic arch and EF 74%. ECG result was sinus bradycardia, total AV block with junctional escape rhythm. Sternotomy and PPM implantation was performed by cardiothoracic surgeon three hours after the baby was born. Post PPM implantation, ECG results was HR 165 bpm and chest X- rays interpretation was cardiomegaly with plethora. Mother and baby came home in good condition on the 6th day of treatment. On the next baby’s control at 4.5 months obtained a weight of 5.4 kg with the echocardiography results was solitus, VSD PM LàR shunt, VSD muscular multiple 3 pieces LàR shunt, PDA LàR shunt, good right and left ventricular function, and left arch. The child got captopril 2x1.5 mg and planned for a 6-month repeat echocardiography.Conclusion : Congenital of total AV block on VSD and PDA is confirmed by prenatal diagnosis and preparation for comprehensive multidisciplinary management.Keywords: congenital total AV block, fetal bradycardia, fetal echocardiography, PPM, ultrasound

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Prenatal Management Strategy for Immune-Associated Congenital Heart Block in Fetuses

Cited by 12 publications

References 69 publications

Case Report: Prenatal Diagnosis and Treatment of Fetal Autoimmune-Associated First-Degree Atrioventricular Block: First Report From China

Case Report: Prenatal Diagnosis and Treatment of Fetal Autoimmune-Associated First-Degree Atrioventricular Block: First Report From China

Autoimmune Disease Classification Based on PubMed Text Mining

A Case of Prenatal Diagnosis of Congenital Total AV Block on VSD and PDA with Ultrasound

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