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Amino H, Kinoshita M, Shibasaki M. Epicardial pacing lead implantation for congenital complete atrioventricular block immediately after birth: a case report. J Med Case Rep 2023; 17:453. [PMID: 37907974 PMCID: PMC10619306 DOI: 10.1186/s13256-023-04190-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 09/25/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND The incidence of congenital complete atrioventricular block is estimated to be 1 per 20,000 deliveries. In the fetal period, the fetal mortality rate is high, but the treatment strategy has not yet been established. In severe cases, early postnatal pacing therapy is necessary. CASE PRESENTATION A 0-day-old Japanese baby girl was diagnosed with fetal congenital complete atrioventricular block during a prenatal physical examination. A joint conference was held preoperatively among multidisciplinary departments, and a cesarean section was performed at 37 weeks pregnancy, immediately followed by scheduled internal ventricular pacing lead implantation in an adjacent room. Percutaneous pacing was ineffective. The epicardial pacing lead was sutured at 17.5 minutes after birth, and perioperative management was successful with a heart rate and pulse rate of 150 beats per minute. CONCLUSION The infant with a congenital complete atrioventricular block was rescued by an uneventful epicardial lead implantation.
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Affiliation(s)
- Hiroaki Amino
- Department of Anesthesiology, Kyoto Prefectural University of Medicine, Kyoto, 602-8566, Japan
| | - Mao Kinoshita
- Department of Anesthesiology, Kyoto Prefectural University of Medicine, Kyoto, 602-8566, Japan.
| | - Masayuki Shibasaki
- Department of Anesthesiology, Kyoto Prefectural University of Medicine, Kyoto, 602-8566, Japan
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2
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Successful transesophageal pacing in a very-low-birth-weight-infant with atrioventricular block. Cardiol Young 2023; 33:318-320. [PMID: 35656569 DOI: 10.1017/s1047951122001706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A baby with complete atrioventricular block was born with a birth weight of 1403 g. Isoproterenol was ineffective and emergency pacing was required. Since transcutaneous pacing was ineffective and transvenous pacing was untenable due to small body size, transesophageal pacing was performed for 3.5 hours until permanent pacemaker implantation. There were no complications. This is the first report of continuous transesophageal pacing in a very-low-birth-weight infant.
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Iqbal M, Umapathi KK, Morales R, Mubayed L, Bokowski JW, Eltayeb O, Nguyen H. Early-Onset Cardiomyopathy After Pacemaker Implanted in a Preterm Infant With Congenital Complete Heart Block and Anti-Ro/SSA Antibodies. Tex Heart Inst J 2021; 48:465444. [PMID: 34086954 DOI: 10.14503/thij-19-7201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Congenital complete heart block is a potentially fatal complication that can occur in neonates whose mothers have autoimmune disorders; it has rarely been reported in the presence of Sjögren syndrome. Pacemaker implantation is recommended to treat rhythm abnormalities in these neonates. We report the case of a late-preterm infant with Sjögren-syndrome-antibody-induced complete heart block who underwent temporary bipolar epicardial pacing as a bridge to permanent pacemaker implantation. Soon after the pacemaker was implanted, takotsubo cardiomyopathy developed. To our knowledge, this is the first report of reversible cardiomyopathy after pacemaker implantation in an infant.
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Affiliation(s)
- Marium Iqbal
- Pediatric Cardiology, Department of Pediatrics, Rush University Medical Center, Chicago, Illinois
| | - Krishna Kishore Umapathi
- Pediatric Cardiology, Department of Pediatrics, Rush University Medical Center, Chicago, Illinois
| | - Raymond Morales
- Pediatric Cardiology, Department of Pediatrics, Rush University Medical Center, Chicago, Illinois
| | - Lamya Mubayed
- Pediatric Cardiology, Department of Pediatrics, Rush University Medical Center, Chicago, Illinois
| | - John W Bokowski
- Pediatric Cardiology, Department of Pediatrics, Rush University Medical Center, Chicago, Illinois
| | - Osama Eltayeb
- Cardiothoracic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Hoang Nguyen
- Pediatric Cardiology, Department of Pediatrics, Rush University Medical Center, Chicago, Illinois
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Khanna P, Arora S, Aravindan A, Prasad G. Anesthetic management of a 2-day-old with complete congenital heart block. Saudi J Anaesth 2014; 8:134-7. [PMID: 24665257 PMCID: PMC3950440 DOI: 10.4103/1658-354x.125977] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Maternal connective tissue disorders such as Systemic Lupus Erythematosus (most common), Sjogren's syndrome, mixed connective tissue disorders may lead to the rare condition of complete congenital heart block in the neonate. Rare fetal syndromes such as myocarditis, 18p syndrome, mucopolysaccharidoses and mitochondrial diseases are other causes. The mortality rate of this condition is inversely propotional to the age of presentation being 6 % in the neonatal age group. As the cardiac output in the neonate is heart rate dependent, it is crucial to maintain the heart rate in these patients. Pharamacological interventions with dopamine, isoprenaline, epinephrine and atropine are known for their variable response. Although permanent pacing is the most reliable mode of management, the access to it is often not readily available, especially in the developing countries. In such cases temporary pacing methods become lifesaving. Of all the modalities of temporary pacing (transcutaneous, transesophageal and transvenous) transcutaneous pacing is the most readily available and immediate mode. In this case report we present a two day old neonate with isolated complete congenital heart block and a resting heart rate of 50-55/min in immediate need of palliative surgery for trachea-esophageal fistula (TEF). With pharmacological intervention the heart rate could only be raised to 75-80/min. The surgery was successfully carried out using transcutaneous pacing to maintain a heart rate of 100/min.
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Affiliation(s)
- Puneet Khanna
- Department of Anesthesiology and Intensive Care, All India Institute of Medical Sciences, New Delhi, India
| | - Shubhangi Arora
- Department of Anesthesiology and Intensive Care, All India Institute of Medical Sciences, New Delhi, India
| | - Ajisha Aravindan
- Department of Anesthesiology and Intensive Care, All India Institute of Medical Sciences, New Delhi, India
| | - Ganga Prasad
- Department of Anesthesiology and Intensive Care, All India Institute of Medical Sciences, New Delhi, India
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5
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Ng O, Shahani SJ. Anaesthetic management of a premature low-birth-weight neonate with congenital complete heart block for implantation of temporary epicardial pacing wires. Singapore Med J 2014; 55:e9-11. [PMID: 24452986 DOI: 10.11622/smedj.2014008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The optimal anaesthetic management of neonates with complete congenital heart block (CCHB) is unknown, as there is a low incidence of such cases. Neonates with CCHB often require surgery for the initiation of electronic pacing. In addition to the challenges of anaesthetising a neonate, this procedure is risky due to the potential for hypotension, arrhythmias and cardiac arrest. We herein present the case of a premature low-birth-weight neonate with antibody-related CCHB and normal heart structure who underwent anaesthesia and surgery for epicardial pacing wire insertion on Day 1 of life. We also compare our patient's anaesthetic conduct and outcome with similar previously reported cases.
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Affiliation(s)
- Oriana Ng
- Department of Anaesthesiology, Block 6, Level 2, Singapore General Hospital, Outram Road, Singapore 169608.
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6
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Karande T, Garekar S, Kulkarni S, Rao S. Staged pacemaker implantation in a preterm with hydrops fetalis due to complete heart block. Ann Pediatr Cardiol 2013; 6:99-100. [PMID: 23626451 PMCID: PMC3634263 DOI: 10.4103/0974-2069.107249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- Tanuja Karande
- Department of Pediatric Cardiology, Children's Heart Centre, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, Maharashtra, India E-mail:
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7
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Controversies in the therapy of isolated congenital complete heart block. J Cardiovasc Med (Hagerstown) 2010; 11:426-30. [PMID: 20421761 DOI: 10.2459/jcm.0b013e3283397801] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Controversies in the therapy of congenital complete heart block are reviewed in terms of the timing of pacemaker implantation, the type and complications of pacing and its role in the presence of myocardial dysfunction. Drug treatment may be useful in selected cases in the presence of pleural effusions, ascites and hydrops of the fetus, but have no effect on complete heart block. Administration of fluorinated steroids in anti-Ro antibody-positive mothers with the aim of preventing complete heart block has given controversial results. Because of the variety of the clinical presentations, especially in regard to pacing therapy, it is mandatory to refer patients with congenital complete heart block to specialized centers with adequate resources and experienced personnel.
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Hayashi T, Kaneko M, Kim KS, Eryu Y, Shindo T, Isoda T, Murashima A, Ito Y, Sago H. Outcome of prenatally diagnosed isolated congenital complete atrioventricular block treated with transplacental betamethasone or ritodrine therapy. Pediatr Cardiol 2009; 30:35-40. [PMID: 18661167 DOI: 10.1007/s00246-008-9273-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2008] [Revised: 05/14/2008] [Accepted: 07/06/2008] [Indexed: 11/26/2022]
Abstract
The effectiveness of transplacental drug therapy for prenatally diagnosed isolated congenital complete atrioventricular block (CCAVB) is controversial. Nine cases of prenatal isolated CCAVB were treated from 2002 to 2007. Ritodrine was administered transplacentally to all fetuses and betamethasone to those whose mothers tested positive for maternal anti-SSA/Ro antibodies. Six of the nine patients had an anti-SSA/Ro-positive mother and received transplacental betamethasone 4 mg/day at a median gestational age of 28 weeks (range, 24-31 weeks). No patients exhibited an improvement in the degrees of complete heart block, and one patient died in utero. No serious adverse events occurred. After the mean follow-up period of 1.7 +/- 1.3 years, all five patients treated with transplacental betamethasone experienced a good cardiac function, whereas one of the three patients not treated with transplacental betamethasone experienced cardiomyopathy and died at the age of 4 months. Pacemaker implantation was required for seven of the eight live-born infants. Transplacental betamethasone therapy for the patients with isolated CCAVB neither improved the degree of atrioventricular block nor decreased the rate of patients requiring pacemaker implantation, but it probably reduced the risk for the development of myocardial disease.
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Affiliation(s)
- Taiyu Hayashi
- Division of Pediatric Cardiology, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan.
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9
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Outcome of high-risk neonates with congenital complete heart block paced in the first 24 hours after birth. J Thorac Cardiovasc Surg 2008; 136:767-73. [PMID: 18805283 DOI: 10.1016/j.jtcvs.2008.04.019] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2007] [Revised: 02/05/2008] [Accepted: 04/11/2008] [Indexed: 11/22/2022]
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Filippi L, Vangi V, Murzi B, Moschetti R, Colella A. Temporary epicardial pacing in an extremely low-birth-weight infant with congenital atrioventricular block. CONGENIT HEART DIS 2008; 2:199-202. [PMID: 18377466 DOI: 10.1111/j.1747-0803.2007.00098.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Congenital atrioventricular block is a rare, but severe occurrence in the newborn can be related to various cardiac malformations or to maternal autoimmune diseases, particularly systemic lupus erythematosus. We report an extremely low-birth-weight infant affected by congenital heart block, due to positive anti-RO/SSA and anti-LA/SSB antibodies of the mother, with progressively increasing respiratory distress syndrome and heart failure. The infant was successfully treated with an external constant-current, single-chamber ventricular (VVI) temporary epicardial pacing, placed on the second day of life, at the weight of 810 g. After this treatment, cardiac failure resolved and respiratory assistance could be rapidly stopped. A single-chamber, rate-responsive, permanent pacemaker was placed at 3 months of life with steroid-eluting, epicardial-pacing leads. We emphasize that early extrathoracic temporary epicardial pacing is able to resolve heart failure in an extremely low-birth-weight infant.
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Affiliation(s)
- Luca Filippi
- Neonatal Intensive Care Unit, Department of Critical Care Medicine, Meyer University Hospital, Florence, Italy.
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11
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Friedman DM, Rupel A, Buyon JP. Epidemiology, etiology, detection, and treatment of autoantibody-associated congenital heart block in neonatal lupus. Curr Rheumatol Rep 2007; 9:101-8. [PMID: 17502039 DOI: 10.1007/s11926-007-0003-4] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Neonatal lupus syndrome is a model of passively acquired autoimmunity in which the pregnant woman's serum contains specific antibodies to 52 or 60 kd SSA/Ro and/or 48 kd SSB/La, which cross the placenta and are associated with the development of congenital heart block in the fetus and/or a transient rash or various liver and blood cell abnormalities in the newborn. To date, congenital heart block is a permanent condition that entails significant morbidity and mortality, with nearly all affected infants requiring pacemakers and with an 80% cumulative probability of survival at 3 years of age. An intensive search is on for the specific etiopathophysiology and for new clinical tools to approach and treat this disease.
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MESH Headings
- Autoantibodies/blood
- Comorbidity
- Heart Block/diagnosis
- Heart Block/drug therapy
- Heart Block/etiology
- Heart Block/mortality
- Heart Defects, Congenital/diagnosis
- Heart Defects, Congenital/drug therapy
- Heart Defects, Congenital/etiology
- Heart Defects, Congenital/mortality
- Humans
- Infant, Newborn
- Infectious Disease Transmission, Vertical
- Lupus Erythematosus, Systemic/complications
- Lupus Erythematosus, Systemic/diagnosis
- Lupus Erythematosus, Systemic/diet therapy
- Lupus Erythematosus, Systemic/mortality
- Survival Rate
- United States/epidemiology
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Affiliation(s)
- Deborah M Friedman
- New York University School of Medicine, 560 First Avenue, TCH-407, New York, NY 10016, USA
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12
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Abstract
Neonatal lupus has become an important model of passively acquired autoimmunity since the seminal observation in the late 1970s that sera from nearly all mothers of children with isolated congenital heart block (CHB) contain specific autoantibodies.
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Affiliation(s)
- Peter M Izmirly
- Department of Medicine, Division of Rheumatology, New York University School of Medicine, 560 First Avenue, TCH-407, New York, NY 10016, USA
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13
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Khositseth A, Samankatiwat P, Withurawanit W, Khowsathit P. Pacing in Preterm with Hydrops Fetalis Due to Congenital Complete Heart Block. Asian Cardiovasc Thorac Ann 2006; 14:428-31. [PMID: 17005895 DOI: 10.1177/021849230601400518] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Hydrops fetalis due to congenital complete heart block (CCHB) is a rare condition. The outcome of the preterm fetus with hydrops fetalis due to CCHB is poor, and is frequently associated with significant morbidity and mortality. The management of this condition is difficult. We report our experience in a hydropic preterm using staged pacing by applying left ventricular epicardial pacing with a temporary pacemaker and subsequently, left ventricular epicardial pacing with a permanent pacemaker.
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Affiliation(s)
- Anant Khositseth
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Bangkok 10400, Thailand.
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15
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Mellander M. Perinatal management, counselling and outcome of fetuses with congenital heart disease. Semin Fetal Neonatal Med 2005; 10:586-93. [PMID: 16213201 DOI: 10.1016/j.siny.2005.08.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Prenatal treatment options for fetal heart disease are still limited but pharmacological treatment of fetal tachyarrhythmias is usually effective. Prenatal catheter interventions are likely to be an option in selected fetal cardiac defects in the future. Delivery should be at a tertiary care centre if the need for immediate neonatal transport is anticipated. When a cardiac problem is diagnosed in a fetus, the parents should be counselled by a paediatric cardiologist specialized in fetal cardiology in close co-operation with the obstetric team. The rate of termination is influenced by gestational age at diagnosis, the severity of the heart defect and the presence of associated malformations. In fetuses with isolated cardiac malformations who are in sinus rhythm with good myocardial function and no or trivial atrioventricular valve regurgitation, the risk of spontaneous intra-uterine death is low. Prenatal echocardiography has the potential to improve postnatal survival in infants with critical heart defects, especially those with duct-dependent systemic or pulmonary circulations.
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Affiliation(s)
- Mats Mellander
- Department of Paediatric Cardiology, The Queen Silvia Children's Hospital, 416 85 Göteborg, Sweden.
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Kussman BD, Madril DR, Thiagarajan RR, Walsh EP, Laussen PC. Anesthetic management of the neonate with congenital complete heart block: a 16-year review. Paediatr Anaesth 2005; 15:1059-66. [PMID: 16324024 DOI: 10.1111/j.1460-9592.2005.01634.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Anesthesia for patients with complete heart block can be associated with significant hemodynamic instability. The aim of this study is to review our anesthetic experience of neonates with congenital complete heart block (CCHB) who underwent placement of either a temporary epicardial pacing system or a permanent epicardial pacemaker. METHODS The anesthetic management of neonates with CCHB who underwent pacemaker placement at a single institution over a 16-year period was reviewed. RESULTS Twenty-four neonates were identified, 17 with a structurally normal heart (NL) and seven with associated congenital heart defects (CHD). Median (range) gestational age was 36.9 (26-41) weeks, birth weight 2.9 (1.0-4.1) kg, and baseline heart rate 47 (38-80) b.min(-1). A temporary epicardial pacing system was placed in six patients (four CHD, two NL; P = 0.003) following institution of mechanical ventilation and inotropic support for a low cardiac output state, and a permanent epicardial pacemaker was placed in 18 patients. Atropine 0.02 mg.kg(-1) IV prior to induction (n = 5) increased heart rate less than 20%. Intraoperative hypotension was documented in nine neonates, five of seven with CHD and four of 17 with NL (P = 0.02). In four patients (44%) hypotension occurred despite concurrent inotropic support. Intraoperative cardiac arrest occurred in one neonate, necessitating institution of extracorporeal membrane oxygenation. Two patients (8.3%) died in hospital from complex CHD and complications of prematurity. CONCLUSIONS Early institution of mechanical ventilation, inotropic support and pacing are necessary in the neonate with CCHB and poor hemodynamic function, particularly with coexisting CHD or prematurity.
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Affiliation(s)
- Barry D Kussman
- Department of Anesthesiology, Perioperative and Pain Medicine, Children's Hospital Boston, MA 02115, USA.
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Lucas JF, Bradley SM, Eicher D, Sigler M, Paul T. Fatal complete atrioventricular block as a complication of bacterial sepsis in a premature newborn. Pediatr Cardiol 2005; 26:677-9. [PMID: 16132286 DOI: 10.1007/s00246-005-0854-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We report on a premature infant with a body weight < 900 g who developed complete heart block as a complication of Enterobacter bacteremia. The infant could be successfully paced using a transcutaneous pacemaker for a limited time. Histopathological examination of the heart did not reveal any abnormalities of the specialized conduction system.
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Affiliation(s)
- J F Lucas
- The Children's Heart Program of South Carolina, Medical University of South Carolina, 165 Ashley Avenue, P.O. Box 250915, Charleston, SC 29425, USA.
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Haas NA, Kulasekaran K, Camphausen C. Beneficial hemodynamic response of transthoracic cardiac pacing in a 2 kg preterm neonate. Intensive Care Med 2005; 31:877-9. [PMID: 15812627 DOI: 10.1007/s00134-005-2610-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2004] [Accepted: 03/02/2005] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe the beneficial hemodynamic effect of transthoracic external pacing compared with epicardial pacing in a 2 kg premature neonate with congenital complete heart block, hydrops and complex congenital heart disease. METHODS Transthoracic epicardial pacing was instituted at a rate of 120 beats/min to treat life-threatening bradycardia (HR 50-60 beats/min), hypotension (BP 45/20 mmHg) and severe lactic acidosis (pH 7.18, lactate 7.5 mmol/l) despite significant catecholamine support. Due to the size of the patient, the external pacing electrodes were placed on the back and front of the patient's chest. To achieve ventricular capture, the electric output had to be increased to 140 mA, resulting in symmetric chest movements. RESULT Transthoracic pacing resulted in an immediate improvement of the cardiovascular status, with an adequate blood pressure (BP 60/25 mmHg) and normalization of acid-base-balance. After the insertion of an epicardial pacemaker (paced rate at 140 beats/min), a significantly lower blood pressure was achieved (BP 50/25 mmHg), indicating an additive effect of the rhythmic chest movements to the blood pressure. Unfortunately, third-degree burns were detected on the patients back 1 day after pacemaker insertion. CONCLUSION Transthoracic pacing is a life-saving option in an emergency situation, when maximal pharmacological support fails to maintain adequate cardiac output. It may have some additional beneficial effect on blood pressure generation in these patients. To prevent skin injury, the output used needs to be as low as feasible, and the period of pacing as brief as practicable.
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Affiliation(s)
- Nikolaus A Haas
- Department of Paediatric Intensive Care, The Prince Charles Hospital, Brisbane, Australia.
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Dell'Orfano J, Chou HA, Park D, Mirza H, Stys T, Mahan V, Zavitz DH, Petrikovsky BM, Ovadia M. The monolithic fetal pacemaker: prototype lead design for closed thorax deployment. Pacing Clin Electrophysiol 2003; 26:805-11. [PMID: 12715839 DOI: 10.1046/j.1460-9592.2003.t01-1-00143.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Prenatal sudden cardiac death and hydrops fetalis are often due to complete heart block. However, no pacing modality exists for intrauterine application for fetal bradycardia. A prototype lead for a novel fetal pacemaker has been developed and used in a direct pacing model. It has been demonstrated that the lead can be safely and successfully deployed using a hypochondriac and transdiaphragmatic or subxiphoid approach. Pacing with ventricular capture was evident with the widening of QRS duration from 50.2 +/- 9.8 to 95.1 +/- 12.8 ms (P = 0.0001). Further studies by echocardiogram revealed an increase in the pulse with pacing, confirming pacing. This study documents proof-of-concept for closed thorax over-the-wire deployment of a novel lead design applicable to fetal pacing. By combining the lead design with microcircuitry and a small power source, it is possible to create a monolithic fetal pacemaker system capable of being deployed in utero.
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Abstract
Neonatal lupus is a disease characterized by one or more of the following findings: congenital heart block, cardiomyopathy, cutaneous lupus lesions, hepatobiliary disease, and thrombocytopenia. Accumulating evidence indicates that the disease is probably caused by maternal autoantibodies, particularly autoantibodies of the Ro family. While often initially asymptomatic, mothers tend to develop symptoms of connective tissue disease. This review discusses the recent advances in the understanding of neonatal lupus, its clinical features, therapy, and pathogenesis.
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Affiliation(s)
- L A Lee
- Department of Dermatology, University of Colorado School of Medicine, 4200 East Ninth Avenue, Denver, CO 80262, USA.
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Yamada H, Kato EH, Ebina Y, Moriwaki M, Yamamoto R, Furuta I, Fujimoto S. Fetal treatment of congenital heart block ascribed to anti-SSA antibody: case reports with observation of cardiohemodynamics and review of the literature. Am J Reprod Immunol 1999; 42:226-32. [PMID: 10580604 DOI: 10.1111/j.1600-0897.1999.tb00095.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
PROBLEM Maternal anti-SSA(B) antibody crosses the placenta and causes fetal myocarditis, congenital heart block (CHB), hydrops fetalis, and intrauterine fetal death. The aim of this study was to evaluate corticosteroids' efficacy as a treatment for CHB. METHOD OF STUDY One fetus with complete CHB and one fetus with incomplete CHB due to anti-SSA(B) antibody received maternal prednisolone (PSL) and dexamethasone (DEXA) treatments. Heart rate, cardiothoracic ratio (CTR), left ventricular fractional shortening (FS), and preload index (PLI) were longitudinally measured by serial fetal echocardiograms. RESULTS In the former case, after maternal PSL/DEXA administration, improvement of cardiohemodynamics, i.e., the reduction of PLI from 1.7 to 0.4, CTR from 70 to 52%, and FS from 63 to 54% were observed. In the latter case, second degree 2:1 block was converted to 3:2 block/sinus rhythm, resulting in the increase of the fetal heart rate from 65 to 116 beats per minute (bpm). CONCLUSIONS We disclosed for the first time the beneficial effects of corticosteroids in the fetal cardiohemodynamics and conduction system of affected fetuses with the presence of maternal anti-SSA(B) antibodies.
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Affiliation(s)
- H Yamada
- Department of Obstetrics and Gynecology, Hokkaido University School of Medicine, Sapporo, Japan.
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