ABSTRACT
Fetal echocardiography has recently caused an impact on the treatment of congenital heart disease and in the field of therapeutic, cardiological intervention. The present study reports on a case of critical aortic stenosis, diagnosed in utero at 27 weeks' gestation, and in which balloon dilatation was attempted to improve the poor prognosis associated with this condition. Since the endocardium at this stage of development was apparently normal, this therapeutic intervention was attempted to avoid irreversible damage to the left ventricle. Although hydrops disappeared and the myocardium hypertrophied, endocardial fibroelastosis progressed and the neonate died within the first day of life, after surgical aortic valvotomy. More data are necessary to clarify whether endocardial fibroelastosis is really a consequence of high pressure in the left ventricle resulting from stenosis of the aortic valve or whether it is a disease, the progression of which is unavoidable once it takes hold.
Subject(s)
Aortic Valve Stenosis/therapy , Catheterization , Fetal Diseases/therapy , Ultrasonography, Prenatal , Adult , Aortic Valve Stenosis/diagnostic imaging , Aortic Valve Stenosis/pathology , Fatal Outcome , Female , Fetal Diseases/diagnostic imaging , Gestational Age , Humans , Infant, Newborn , Male , PregnancyABSTRACT
A case of idiopathic ventricular tachycardia of left ventricular origin in a hydropic fetus is presented. The accuracy of fetal echocardiography for diagnosing this type of arrhythmia is emphasized, as is its importance in determining appropriate postnatal treatment which in this case resulted in an unusually benign course.
Subject(s)
Hydrops Fetalis/diagnostic imaging , Tachycardia, Ventricular/diagnostic imaging , Ultrasonography, Prenatal , Ventricular Dysfunction, Left/diagnostic imaging , Adult , Amiodarone/therapeutic use , Anti-Arrhythmia Agents/therapeutic use , Echocardiography , Electrocardiography , Female , Fetal Diseases/diagnostic imaging , Humans , Hydrops Fetalis/complications , Infant, Newborn , Male , Pregnancy , Tachycardia, Ventricular/complications , Tachycardia, Ventricular/drug therapy , Ventricular Dysfunction, Left/complications , Ventricular Dysfunction, Left/drug therapyABSTRACT
Fetal echocardiography was performed during the third trimester in a normal primigravida. The fetal heart was severely affected with the typical cardiac manifestations of Marfan syndrome. The medical history of the father was investigated and a mild form of the syndrome was diagnosed. The neonate died at 2 months of age of congestive heart failure.
Subject(s)
Marfan Syndrome/diagnostic imaging , Adult , Echocardiography , Fatal Outcome , Female , Fetal Diseases/diagnostic imaging , Humans , Pregnancy , Pregnancy Trimester, Third , Ultrasonography, PrenatalABSTRACT
A healthy pregnant was referred at 34 weeks gestation because an obstetrical ultrasound examination had shown fetal bradycardia and nonimmune hydrops. The heart was anatomically normal but complete heart block was present with a ventricular rate of 22bpm and atrial of 101bpm. We injected isoproterenol by cordocentesis direct in the umbilical vein of the fetus and a significant increase into the ventricular and atrial rates were obtained. The direct therapy with sympathomimetic drugs is a simple technique and may save fetuses with complete heart block and hidrops.
Subject(s)
Fetal Diseases/drug therapy , Heart Block/drug therapy , Isoproterenol/therapeutic use , Adult , Female , Heart Block/complications , Humans , Hydrops Fetalis/etiologyABSTRACT
PURPOSE: To study the pathogenesis, evolution and prognosis of the complete heart block of the fetus. METHODS: Bidimensional echocardiography associated to M-mode and doppler was performed in 600 patients. All cases of congenital heart block were referred because the fetuses presented hydrops, bradycardia and/or cardiac malformation suspected by routine ultrasound. RESULTS: Isolated heart block was found in 6 fetuses (5 cases of complete type and 1 case of 2nd degree type 2:1). Heart block associated with complex cardiac disease and left atrial isomerism was found in 6 fetuses with no survivors (5 cases of complete type and 1 case of 2nd degree type 2:1). Heart block associated with atrioventricular discordante was found in 1 case. CONCLUSION: The findings of this study agree the literature about the relation between maternal anti-RO antibodies and isolated complete heart block. We also found a poor prognosis in the group with heart block and complex cardiac malformations.
Subject(s)
Fetal Diseases/diagnosis , Heart Block/diagnosis , Brazil/epidemiology , Connective Tissue Diseases/diagnosis , Connective Tissue Diseases/epidemiology , Echocardiography/instrumentation , Electrocardiography , Female , Fetal Diseases/epidemiology , Heart Block/epidemiology , Humans , Incidence , Infant, Newborn , Pregnancy , Prognosis , Ultrasonography, Prenatal/instrumentationABSTRACT
A cordocentese representa um importante avanco em Obstetricia, permitindo diagnosticar, tratar e acompanhar inumeras patologias que afetam o feto. Entretanto, em vista do carater invasivo dessa tecnica, a sua indicacao precisa ser criteriosa. Os autores discutem as principais indicacoes da cordocentese aceitas na atualidade: isoimunizacao ao fator Rh, gestantes com patologias plaquetarias, cariotipagem rapida, esclarecimento de mosaicismo e crescimento intra-uterino retardado. Os riscos da cordocentese relacionam-se com a gravidade do caso e habilidade do operador. As principais causas de perdas fetais foram: corioamnionite, amniorrexe prematura, hemorragia fetal, bradicardia e trombose dos vasos umbilicais.
Subject(s)
Fetal Diseases , Fetoscopy , Rh Isoimmunization , RiskABSTRACT
Vinte e quatro pacientes de sexo feminino, acometidas por infeccoes do trato urinario que procuraram o Pronto-Socorro de Ginecologia do Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, foram tratadas com acido pipemidico, 400 mg 2 vezes ao dia por via oral, por um periodo de sete dias. Do estudo foram excluidas pacientes com molestia imflamatoria pelvica, vulvovaginites ou gestantes.Exame de urina tipo I, cultura e teste de sensibilidade bacteriana foram realizados antes e 10 dias apos o tratamento. O agente mais frequente encontrado foi o E. coli seguido por Staphylococcus saprophyticus, alem de Proteus mirabilis e Citrobacter sp O acido pipemidico mostrou-se altamente eficaz, proporcionando cura bacteriologica e desaparecimento ou melhora da sintomatologia em 87,5% dos casos. A tolerabilidade do medicamento foi muito boa, tendo sido observado apenas um caso de desconforto abdominal e um outro de sensacao de plenitude epigastrica com prurido cutaneo generalizado, anbos transitorios e de leve intensidade