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1.
Ultrasound Obstet Gynecol ; 54(1): 7-9, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31313868

RESUMO

Linked Comment: Ultrasound Obstet Gynecol 2019; 54: 87-95.


Assuntos
Anticorpos Antinucleares , Bloqueio Cardíaco , Ecocardiografia , Feminino , Bloqueio Cardíaco/congênito , Humanos , Gravidez
2.
Tex Heart Inst J ; 46(2): 136-138, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31236081

RESUMO

Congenital complete heart block with concomitant biventricular noncompaction cardiomyopathy has been reported once previously. Although not universal, when restrictive physiology is present, impaired diastolic filling may pose a distinct challenge to pacing during the neonatal period. We present the case of a neonate with congenital complete heart block and biventricular noncompaction that resulted in severe diastolic dysfunction and atrioventricular dyssynchrony. We intentionally used 2:1 ventricular pacing to provide atrioventricular synchrony with every paced beat, and this resulted in hemodynamic and clinical improvement. This unconventional pacing technique may be beneficial in other neonates who have complete heart block and diastolic dysfunction.


Assuntos
Anormalidades Múltiplas , Estimulação Cardíaca Artificial/métodos , Bloqueio Cardíaco/congênito , Cardiopatias Congênitas/terapia , Ventrículos do Coração/anormalidades , Eletrocardiografia , Seguimentos , Bloqueio Cardíaco/diagnóstico , Bloqueio Cardíaco/terapia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/fisiopatologia , Humanos , Recém-Nascido , Masculino
3.
Reumatol. clín. (Barc.) ; 15(2): 109-112, mar.-abr. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-184358

RESUMO

El síndrome de Sjögren primario (SSp) afecta preferentemente al sexo femenino. Los informes sobre la evolución de los embarazos en estas pacientes son pocos y contradictorios. Objetivo: Describir las características del embarazo y su desenlace en mujeres con SSp, así como la morbilidad del recién nacido. Material y métodos: Se incluyeron pacientes con SSp que quedaron embarazadas luego del comienzo de los síntomas de dicha enfermedad. Se describieron las características clínicas y serológicas, los factores de riesgo y las comorbilidades maternas previas. Se detalló la evolución de cada embarazo, el desenlace y las características del recién nacido. Resultados: Se evaluaron 11 pacientes con 18 embarazos posteriores al inicio de síntomas: todas presentaban FAN+; 10 anti-Ro/SSA+ y 7 anti-La/SSB+. El promedio de edad en años al inicio de los síntomas fue de 24,9 (DE 6,9) y al momento del embarazo fue de 30,3 (DE 5,4). Hubo 13 embarazos previos al diagnóstico, reportándose solo un aborto espontáneo. Después de la presentación del SSp, se informaron: 2 partos prematuros, un oligoamnios, 2 roturas prematuras de membranas y 2 recién nacidos con bajo peso al nacer. Se halló un caso con bloqueo cardíaco congénito y otro con lupus cutáneo neonatal. Todas las mujeres con complicaciones obstétricas (6) presentaban Ac anti-Ro/SSA+, 5 con Ac anti-La/SSB+. Quienes no tuvieron complicaciones (5): 2 presentaban anti-Ro/SSA y anti-La/SSB+, y 2 solo anti-Ro/SSA. Conclusiones: Casi la mitad de los embarazos de las pacientes con SSp analizados presentaron alguna complicación no atribuible a otro factor distinto de su enfermedad de base


Primary Sjögren's syndrome (pSS) is a condition that predominantly affects women. Reports of pregnancy outcome in these patients are limited and contradictory. Objective: To describe pregnancy characteristics and outcomes and newborn morbidity in women with pSS. Material and methods: We included women with pSS who became pregnant after the onset of the symptoms of the disease. Clinical and serological characteristics, risk factors and previous maternal comorbidities are described. For each pregnancy in a woman with pSS, we recorded pregnancy course and outcome and newborn condition. Results: We assessed 11 patients with 18 pregnancies after the onset of pSS symptoms. All of them presented FAN +; 10 anti-Ro / SSA + and 7 anti-La / SSB +. The mean age in years at the onset of symptoms was 24.9 (SD 6.9) and at the time of pregnancy was 30.3 (SD 5.4). Thirteen pregnancies happened before the diagnosis, reporting only one miscarriage. Two preterm births, 1 case of oligohydramnios, 2 of premature membrane rupture and 2 low birthweight babies were reported after the onset of pSS symptoms. There was 1 newborn with congenital atrioventricular block and another with neonatal cutaneous lupus. All the women with pregnancy complications (n=6) had anti-Ro/SSA antibodies. Conclusions: Almost half of the pregnancies assessed in women with pSS were associated with complications not attributable to factors other than the disease


Assuntos
Humanos , Feminino , Gravidez , Adolescente , Adulto Jovem , Adulto , Síndrome de Sjogren/complicações , Complicações na Gravidez/epidemiologia , Resultado da Gravidez/epidemiologia , Doenças do Recém-Nascido/epidemiologia , Bloqueio Cardíaco/congênito , Estudos Retrospectivos
5.
Artigo em Inglês | MEDLINE | ID: mdl-30738635

RESUMO

Fetal dysrhythmias are common abnormalities, usually manifesting as irregular rhythms. Although most irregularities are benign and caused by isolated atrial ectopics, in a few cases, rhythm irregularity may indicate partial atrioventricular block, which has different etiological and prognostic implications. We provide a flowchart for the initial management of irregular rhythm to help select cases requiring urgent specialist referral. Tachycardias and bradycardias are less frequent, can lead to hemodynamic compromise, and may require in utero therapy. Pharmacological treatment of tachycardia depends on the type (supraventricular tachycardia or atrial flutter) and presence of hydrops, with digoxin, flecainide, and sotalol being commonly used. An ongoing randomized trial may best inform about their efficacy. Bradycardia due to blocked bigeminy normally resolves spontaneously, but if it is due to established complete heart block, there is no effective treatment. Ongoing research suggests hydroxychloroquine may reduce the risk of autoimmune atrioventricular block. Sinus bradycardia (rate <3rd centile) may be a prenatal marker for long-QT syndrome.


Assuntos
Arritmias Cardíacas/diagnóstico , Doenças Fetais/diagnóstico , Frequência Cardíaca Fetal , Arritmias Cardíacas/terapia , Ecocardiografia , Feminino , Doenças Fetais/terapia , Terapias Fetais/métodos , Bloqueio Cardíaco/congênito , Bloqueio Cardíaco/diagnóstico , Bloqueio Cardíaco/terapia , Humanos , Gravidez , Medição de Risco , Ultrassonografia Doppler , Ultrassonografia Pré-Natal
6.
Ann Rheum Dis ; 78(5): 696-703, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30808622

RESUMO

OBJECTIVE: Congenital heart block (CHB) may develop in fetuses of Ro/SSA autoantibody-positive women. Given the rarity of CHB, information on comorbidity and complications later in life is difficult to systematically collect for large groups of patients. We therefore used nation-wide healthcare registers to investigate comorbidity and outcomes in patients with CHB and their siblings. METHODS: Data from patients with CHB (n= 119) and their siblings (n= 128), all born to anti-Ro/SSA-positive mothers, and from matched healthy controls (n= 1,190) and their siblings (n= 1,071), were retrieved from the Swedish National Patient Register. Analyses were performed by Cox proportional hazard modelling. RESULTS: Individuals with CHB had a significantly increased risk of cardiovascular comorbidity, with cardiomyopathy and/or heart failure observed in 20 (16.8%) patients versus 3 (0.3%) controls, yielding a HR of 70.0 (95% CI 20.8 to 235.4), and with a HR for cerebral infarction of 39.9 (95% CI 4.5 to 357.3). Patients with CHB also had a higher risk of infections. Pacemaker treatment was associated with a decreased risk of cerebral infarction but increased risks of cardiomyopathy/heart failure and infection. The risk of systemic connective tissue disorder was also increased in patients with CHB (HR 11.8, 95% CI 4.0 to 11.8), and both patients with CHB and their siblings had an increased risk to develop any of 15 common autoimmune conditions (HR 5.7, 95% CI 2.83 to 11.69 and 3.6, 95% CI 1.7 to 8.0, respectively). CONCLUSIONS: The data indicate an increased risk of several cardiovascular, infectious and autoimmune diseases in patients with CHB, with the latter risk shared by their siblings.


Assuntos
Anticorpos Antinucleares/imunologia , Autoanticorpos/imunologia , Bloqueio Cardíaco/congênito , Exposição Materna/efeitos adversos , Efeitos Tardios da Exposição Pré-Natal/imunologia , Adolescente , Adulto , Doenças Autoimunes/imunologia , Criança , Pré-Escolar , Comorbidade , Feminino , Bloqueio Cardíaco/imunologia , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Linhagem , Gravidez , Complicações na Gravidez/imunologia , Sistema de Registros , Irmãos , Suécia , Adulto Jovem
7.
Rev Med Liege ; 74(2): 95-99, 2019 Feb.
Artigo em Francês | MEDLINE | ID: mdl-30793563

RESUMO

Immunologic congenital atrioventricular block is due to the presence of anti-SSA and anti-SSB antibodies in maternal blood. This pathology is often diagnosed when the status is irreversible and is consequently associated with a high morbi-mortality. Close monitoring for high risk pregnancies can help to diagnose first and second degrees heart block and treatments can be offered when the block is still reversible. Fluorocorticoids, betamimetics and hydroxychloroquine use is not consensual. Studies are still in progress to prove their utility. We report the antenatal managing of a patient in which Goujerot-Sjögren disease was diagnosed after the revealing of an atrioventricular block in her fetus. After a brief physiopathological description, we present the current knowledge in preventive and curative treatments.


Assuntos
Anticorpos Antinucleares , Bloqueio Cardíaco/congênito , Complicações na Gravidez , Síndrome de Sjogren , Feminino , Bloqueio Cardíaco/complicações , Bloqueio Cardíaco/diagnóstico , Humanos , Gravidez , Complicações na Gravidez/diagnóstico , Síndrome de Sjogren/diagnóstico
8.
Ultrasound Obstet Gynecol ; 54(1): 87-95, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30620419

RESUMO

OBJECTIVES: Assuming that autoimmune congenital heart block (CHB) is a progressive disease amenable to therapeutic modulation, we introduced a surveillance program for at-risk pregnancies with the dual aim of investigating if fetal atrioventricular block (AVB) could be detected and treated before becoming complete and irreversible, and to establish the incidence of AVB I, II and III in a large prospective cohort. METHODS: This was a prospective study of 212 anti-Ro52 antibody-exposed pregnancies at risk of fetal AVB that were followed weekly between 18 and 24 weeks' gestation at our tertiary fetal cardiology center from 2000 to 2015. A 12-lead electrocardiogram (ECG) was recorded within 1 week after birth. Fetal Doppler atrioventricular (AV) intervals were converted to Z-scores using reference standard values derived from normal pregnancies. Each fetus was represented by the average value of the two recordings, obtained at two consecutive visits, which resulted in the longest AV interval. AV interval values were classified into normal AV conduction (Z-score ≤ 2.0) and three levels of delayed AV conduction: Z-score > 2.0 and ≤ 3.0, Z-score > 3.0 and ≤ 4.0, and Z-score > 4.0. RESULTS: AVB II or III developed in 6/204 (2.9%) pregnancies without a CHB history and 1/8 (12.5%) of those with a CHB history. AV intervals > 2 and ≤ 3, > 3 and ≤ 4, and > 4 were detected in 16.0%, 7.5% and 2.8% of cases, respectively, and were related to the PR interval on 185 available ECGs. Three of the five cases with AVB III and one of two cases with 2:1 AVB II developed within 1 week of AV interval Z-score of 1.0, 1.9, 2.8 and 1.9, respectively. Transplacental treatment with betamethasone was associated with restoration of 1:1 AV conduction in the two fetuses with AVB II, with a better long-term result (normal ECG vs AVB I or II) observed in the case in which treatment was started within 1 week after AVB developed. Betamethasone treatment did not reverse AVB III, although a temporary effect on AV conduction was observed in 1/5 cases. Notably, the three cases in which treatment was started within 1 week after AVB III development responded with a higher ventricular rate than the other two cases and did not require pacemaker implantation until a later age (2-5 years vs 1.5-2 months). CONCLUSION: Fetal AV interval is a poor predictor of CHB progression, but CHB surveillance still allows detection of fetuses with AVB II or III shortly after its development, allowing for timely treatment initiation and potentially better outcome. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.


Assuntos
Bloqueio Atrioventricular/prevenção & controle , Ecocardiografia/métodos , Coração Fetal/diagnóstico por imagem , Feto/diagnóstico por imagem , Bloqueio Cardíaco/congênito , Bloqueio Atrioventricular/classificação , Bloqueio Atrioventricular/epidemiologia , Bloqueio Atrioventricular/fisiopatologia , Autoanticorpos , Doenças Autoimunes/sangue , Doenças Autoimunes/tratamento farmacológico , Betametasona/administração & dosagem , Betametasona/uso terapêutico , Ecocardiografia Doppler/métodos , Feminino , Coração Fetal/fisiopatologia , Feto/patologia , Idade Gestacional , Glucocorticoides/administração & dosagem , Glucocorticoides/uso terapêutico , Bloqueio Cardíaco/diagnóstico , Bloqueio Cardíaco/imunologia , Bloqueio Cardíaco/fisiopatologia , Humanos , Incidência , Lactente , Recém-Nascido , Gravidez/sangue , Gravidez/imunologia , Estudos Prospectivos , Resultado do Tratamento
9.
J Immunol ; 202(1): 48-55, 2019 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-30518570

RESUMO

Given that diseases associated with anti-SSA/Ro autoantibodies, such as systemic lupus erythematosus and Sjögren syndrome, are linked with an upregulation of IFN and type I IFN-stimulated genes, including sialic acid-binding Ig-like lectin 1 (Siglec-1), a receptor on monocytes/macrophages, recent attention has focused on a potential role for IFN and IFN-stimulated genes in the pathogenesis of congenital heart block (CHB). Accordingly, three approaches were leveraged to address the association of IFN, IFN-stimulated genes, and the phenotype of macrophages in affected fetal cardiac tissue: 1) cultured healthy human macrophages transfected with hY3, an anti-SSA/Ro-associated ssRNA, 2) RNA isolated from freshly sorted human leukocytes/macrophages after Langendorff perfusion of three fetal hearts dying with CHB and three healthy gestational age-matched hearts, and 3) autopsy tissue from three additional human CHB hearts and one healthy heart. TLR ligation of macrophages with hY3 led to the upregulation of a panel of IFN transcripts, including SIGLEC1, a result corroborated using quantitative PCR. Using independent and agnostic bioinformatics approaches, CD45+CD11c+ and CD45+CD11c- human leukocytes flow sorted from the CHB hearts highly expressed type I IFN response genes inclusive of SIGLEC1. Furthermore, Siglec-1 expression was identified in the septal region of several affected fetal hearts. These data now provide a link between IFN, IFN-stimulated genes, and the inflammatory and possibly fibrosing components of CHB, positioning Siglec-1-positive macrophages as integral to the process.


Assuntos
Bloqueio Cardíaco/congênito , Septos Cardíacos/metabolismo , Lúpus Eritematoso Sistêmico/imunologia , Macrófagos/fisiologia , Lectina 1 Semelhante a Ig de Ligação ao Ácido Siálico/metabolismo , Síndrome de Sjogren/imunologia , Adulto , Anticorpos Antinucleares/metabolismo , Autoantígenos/genética , Autoantígenos/metabolismo , Autoimunidade , Células Cultivadas , Feminino , Regulação da Expressão Gênica , Bloqueio Cardíaco/imunologia , Humanos , Interferon Tipo I/genética , Interferon Tipo I/metabolismo , RNA Citoplasmático Pequeno/genética , RNA Citoplasmático Pequeno/metabolismo , Ribonucleoproteínas/genética , Ribonucleoproteínas/metabolismo , Lectina 1 Semelhante a Ig de Ligação ao Ácido Siálico/genética
10.
Spine (Phila Pa 1976) ; 44(4): E252-E257, 2019 02 15.
Artigo em Inglês | MEDLINE | ID: mdl-30086081

RESUMO

STUDY DESIGN: Case report. OBJECTIVE: To describe the technical difficulties on performing posterior spinal fusion (PSF) on a pacemaker-dependent patient with complete congenital heart block and right thoracic scoliosis. SUMMARY OF BACKGROUND DATA: Congenital complete heart block requires pacemaker implantation at birth through thoracotomy, which can result in scoliosis. Corrective surgery in this patient was challenging. Height gain after corrective surgery may potentially cause lead dislodgement. The usage of monopolar electrocautery may interfere with the function of the implanted cardiac device. METHODS: A 17-year-old boy was referred to our institution for the treatment of right thoracic scoliosis of 70°. He had underlying complete congenital heart block secondary to maternal systemic lupus erythematosus. Pacemaker was implanted through thoracotomy since birth and later changed for four times. PSF was performed by two attending surgeons with a temporary pacing inserted before the surgery. The monopolar electrocautery device was used throughout the surgery. RESULTS: The PSF was successfully performed without any technical issues and complications. Postoperatively, his permanent pacemaker was functioning normally. Three days later, he was recovering well and was discharged home from hospital. CONCLUSION: This case indicates that PSF can be performed successfully with thoughtful anticipation of technical difficulties on a pacemaker-dependent patient with underlying congenital heart block. LEVEL OF EVIDENCE: 5.


Assuntos
Bloqueio Cardíaco/congênito , Escoliose/complicações , Escoliose/cirurgia , Fusão Vertebral/métodos , Adolescente , Bloqueio Cardíaco/complicações , Bloqueio Cardíaco/terapia , Humanos , Masculino , Marca-Passo Artificial , Fusão Vertebral/instrumentação , Vértebras Torácicas
11.
Medicine (Baltimore) ; 97(45): e13185, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30407356

RESUMO

RATIONALE: Neonatal lupus erythematosus (NLE) is an infrequent disease caused by transplacental maternal autoantibodies. The most common effects of NLE include cutaneous involvement and congenital heart block (CHB), although it might involve multiple organs, such as the liver, lungs, blood, and nervous or digestive systems. Izmirly PM1 and Tonello et al recently reported cutaneous manifestations of neonatal lupus and risk of subsequent CHB. The most serious complication of NLE is complete atrioventricular (AV) block. PATIENT CONCERNS: We experienced 2 cases of NLE that were diagnosed in the past year in our Neonatal Intensive Care Unit. These cases showed 2 different clinical spectrums (CHB, multisystemic effects). One case was a 32-week pregnant woman with combined liver damage and fever, and her fetus was premature due to bradycardia and pericardial effusion. The second case was a young pregnant woman who had systemic lupus erythematosus for 2 years and had been taking methylprednisolone and hydroxychloroquine for a long time since her illness. When prenatal testing at 28 weeks of pregnancy showed that the fetus had CHB, the mother began taking dexamethasone. DIAGNOSIS: The first case was diagnosed as NLE with CHB after birth, while the second was diagnosed as NLE with CHB, ductus arteriosus, and atrial septal defect when she was born at 34 weeks. INTERVENTIONS: Both of 2 cases were treated with steroids, intravenous immunoglobulin, and a diuretic. But the second case was treated with isoprenaline in addition to the above. OUTCOMES: Both of the infants was followed up and found to be clinically normal. During the clinic follow-up of the first case, the 8-month-old infant was still asymptomatic with normal growth and development. Her heart rate fluctuated from 40 to 90 beats/minute. LESSONS: Autoimmune CHB is a severe, potentially life-threatening disorder associated with passive transfer of maternal anti-Sjogren's syndrome A/Ro and anti-Sjogren's syndrome B/La autoantibodies. Mothers who are positive for these autoantibodies are recommended to have serial echocardiography and obstetric ultrasonography from the early second trimester. Newborns should be delivered at an early stage of gestation if there is evidence of pericardial effusion, ascites, increasing ventricular ectopy, reduced ventricular shortening fraction, or AV valve regurgitation. Aggressive medical management after birth should be coupled with pacemaker implantation in infants who do not respond to medical therapies alone.


Assuntos
Bloqueio Cardíaco/congênito , Lúpus Eritematoso Sistêmico/congênito , Agonistas Adrenérgicos beta/uso terapêutico , Adulto , Autoanticorpos , Diuréticos/uso terapêutico , Feminino , Glucocorticoides/uso terapêutico , Bloqueio Cardíaco/diagnóstico , Bloqueio Cardíaco/tratamento farmacológico , Bloqueio Cardíaco/etiologia , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Recém-Nascido , Isoproterenol/uso terapêutico , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/diagnóstico , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Gravidez , Complicações na Gravidez/imunologia
14.
Rheumatology (Oxford) ; 57(suppl_5): v9-v17, 2018 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-30137589

RESUMO

Objective: To survey an international sample of providers to determine their current practices for the prevention, screening, and treatment of congenital heart block (CHB) due to maternal Ro/SSA antibodies. Methods: A survey was designed by the organizing committee of the 9th International Conference of Reproduction, Pregnancy and Rheumatic Diseases. It was sent to attendants of the conference and authors of recent publications or abstracts at ACR 2012, 2013 or 2014 on rheumatic diseases and pregnancy. Results: In anti-Ro/SSA positive women, 80% of 49 respondents recommended screening by serial fetal echocardiogram (ECHO), with most starting at week 16 (59%) and stopping at week 28 (25%), although the time to stop varied widely. For women without a prior infant with neonatal lupus, respondents recommend every other week (44%) or weekly (28%) fetal ECHOs. For women with a prior infant with neonatal lupus, 80% recommend weekly fetal ECHOs. To prevent CHB, HCQ was recommended by 67% of respondents and most would start pre-pregnancy (62%). Respondents were asked about medications to treat varying degrees of CHB in a 20-week pregnant, anti-Ro and La positive SLE patient. For first degree, respondents recommended starting dexamethasone (53%) or HCQ (43%). For second degree, respondents recommended starting dexamethasone (88%). For third degree, respondents recommended starting dexamethasone (55%) or IVIg (33%), although 27% would not start treatment. Conclusion: Despite the absence of official guidelines, many physicians with a focus on pregnancy and rheumatic disease have developed similar patterns in the screening, prevention and treatment of CHB.


Assuntos
Ecocardiografia , Bloqueio Cardíaco/congênito , Lúpus Eritematoso Sistêmico/congênito , Padrões de Prática Médica/estatística & dados numéricos , Diagnóstico Pré-Natal , Anticorpos Antinucleares/análise , Ecocardiografia/métodos , Feminino , Bloqueio Cardíaco/diagnóstico por imagem , Bloqueio Cardíaco/prevenção & controle , Humanos , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/diagnóstico por imagem , Gravidez , Trimestres da Gravidez/imunologia , Diagnóstico Pré-Natal/métodos , Inquéritos e Questionários
15.
Horm Mol Biol Clin Investig ; 35(2)2018 Aug 25.
Artigo em Inglês | MEDLINE | ID: mdl-30144384

RESUMO

Complete heart block (CHB) is infrequently encountered during pregnancy. Its management requires a multidisciplinary approach involving the obstetrician, cardiologist, anesthetist and neonatologist. It varies from conservative, temporary or permanent pacemaker (PPM) insertion (either during the antenatal, intrapartum or postpartum period). We present the case of a 30-year-old, gravida 2 para 1 at the 36-week period of amenorrhea (POA) with congenital CHB. She was asymptomatic throughout her pregnancy despite having a pulse rate between 40 and 50 beats per minute. She delivered a healthy boy via cesarean section due to breech presentation after a failed external cephalic version. A temporary pacemaker was inserted prior to delivery. However, she required permanent insertion of pacemaker during the postpartum period.


Assuntos
Bloqueio Cardíaco/congênito , Complicações Cardiovasculares na Gravidez/etiologia , Complicações Cardiovasculares na Gravidez/terapia , Adulto , Cesárea , Feminino , Bloqueio Cardíaco/complicações , Bloqueio Cardíaco/diagnóstico , Bloqueio Cardíaco/fisiopatologia , Bloqueio Cardíaco/terapia , Frequência Cardíaca , Humanos , Recém-Nascido , Masculino , Marca-Passo Artificial , Gravidez , Complicações Cardiovasculares na Gravidez/diagnóstico , Complicações Cardiovasculares na Gravidez/fisiopatologia
17.
Interact Cardiovasc Thorac Surg ; 27(3): 469-470, 2018 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-29617782

RESUMO

Permanent pacemaker implantation in small infants can be challenging because of patient size and expected somatic growth. In our case, we used the retrosternal space as a generator pocket for an extremely low-birth-weight premature baby with autoantibody-associated congenital heart block born to a systemic lupus erythematosus mother.


Assuntos
Estimulação Cardíaca Artificial , Bloqueio Cardíaco/congênito , Doenças do Prematuro/terapia , Marca-Passo Artificial , Feminino , Bloqueio Cardíaco/terapia , Humanos , Lactente , Recém-Nascido de Baixo Peso , Recém-Nascido Prematuro
18.
Prenat Diagn ; 38(6): 459-466, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29633288

RESUMO

OBJECTIVE: To establish nomograms for fetal atrioventricular (AV) time intervals assessed by 3 different pulsed-wave Doppler techniques: left ventricular inflow and outflow tracts (LV in/out), superior vena cava and ascending aorta (SVC/AA), and pulmonary artery and pulmonary vein (PA/PV). METHODS: A cross-sectional study was performed in 311 normal fetuses divided into 5 groups between 16 and 38 weeks. Pulsed-wave Doppler-derived AV intervals were measured by interrogation of flow in LV in/out, SVC/AA, and PA/PV. Linear regression analyses were performed to examine correlations with gestational age (GA) and fetal heart rate (FHR). Intraclass correlation coefficients for reproducibility of each method were compared. RESULTS: Pulmonary artery and pulmonary vein revealed the longest mean AV time intervals (P < .001). The AV intervals in all methods were positively correlated with GA (R2  = 0.20-0.36; P < .001) and negatively correlated with FHR (R2  = 0.09-0.19; P < .001). The SCV/AA time intervals demonstrated the weakest influence of FHR. For LV in/out, SVC/AA, and PA/PV, intraobserver and interobserver reliability coefficients showed excellent agreements (all intraclass correlation coefficients ≥ 0.80). CONCLUSION: All pulsed-wave Doppler-derived AV time intervals increased with advancing GA and decreased with increasing FHR. Fetal AV interval measurements can be obtained in a clinically viable fashion with excellent reproducibility.


Assuntos
Coração Fetal/diagnóstico por imagem , Bloqueio Cardíaco/congênito , Estudos Transversais , Ecocardiografia Doppler , Feminino , Bloqueio Cardíaco/diagnóstico por imagem , Humanos , Nomogramas , Gravidez , Estudos Prospectivos , Valores de Referência , Ultrassonografia Pré-Natal
20.
J Clin Ultrasound ; 46(5): 347-350, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29023775

RESUMO

Maternal autoantibodies to Ro/SSA are often linked to congenital heart block and rarely associated with structural defects. We describe the case of a fetus with anti-Ro-mediated second-degree block at 19 weeks, which progressed to a complete block, fibroelastosis, atrioventricular valve insufficiency, and semilunar valve stenosis/insufficiency at 20, 22, 24, and 26 weeks, respectively, although the fetus received transplacental anti-arrhythmic drugs. The 2150-g fetus was vaginally delivered at 35 weeks. An external pacemaker was inserted immediately after birth and replaced with permanent pacemaker at the age of 3 months. The newborn has had a good outcome with well-controlled heart rate.


Assuntos
Anticorpos Antinucleares/efeitos adversos , Anticorpos Antinucleares/sangue , Coração Fetal/diagnóstico por imagem , Bloqueio Cardíaco/congênito , Ultrassonografia Pré-Natal/métodos , Adulto , Antiarrítmicos/uso terapêutico , Autoanticorpos/efeitos adversos , Autoanticorpos/sangue , Feminino , Bloqueio Cardíaco/diagnóstico por imagem , Bloqueio Cardíaco/etiologia , Bloqueio Cardíaco/terapia , Humanos , Marca-Passo Artificial , Gravidez
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