Prenatal diagnosis of complete atrioventricular block associated with structural heart disease: combined experience of two tertiary care centers and review of the literature

Ultrasound Obstet Gynecol. 2005 Jul;26(1):16-21. doi: 10.1002/uog.1919.

Abstract

Objective: To review the pattern of presentation, management and outcome of fetal complete atrioventricular block (CAVB) associated with major structural congenital heart disease (CHD), when compared to isolated CAVB.

Methods: Retrospective analysis of the medical records and echocardiograms of all CAVB cases, diagnosed prenatally at two tertiary care centers between the years 1990 and 2002.

Results: Of a total of 59 consecutive fetal cases of CAVB, 24 (41%) had underlying major CHD, mainly left isomerism (n = 18) and congenitally corrected transposition of the great arteries (cc-TGA) (n = 3). When compared to isolated CAVB (n = 35), cases with CHD were detected earlier (21 +/- 6 vs. 26 +/- 6 weeks; P < 0.02) and-despite comparable heart rates-more often had fetal hydrops (38% vs. 9%; P < 0.02), while pregnancy continuation (66% vs. 94%; P < 0.02) or prenatal treatment (19% vs. 64%; P < 0.001) was less likely. Of 16 CHD cases with pregnancy continuation, beta-inotropic treatment of fetal bradycardia was attempted in three cases: all had left isomerism and died early postnatally. Livebirth and 1-year survival rates of CAVB with CHD were 56% and 19%, respectively, when compared to isolated CAVB with 88% and 75%, respectively (P < 0.0001). The four neonatal survivors (one left isomerism, three cc-TGA) had heart rates persistently > 60 bpm throughout gestation and 3/4 underwent a biventricular repair.

Conclusions: Fetal CAVB with CHD continues to be associated with a poor outcome, in particular in the presence of left isomerism and fetal heart rates < 60 bpm.

Publication types

  • Multicenter Study
  • Review

MeSH terms

  • Echocardiography / methods*
  • Echocardiography, Doppler / methods
  • Female
  • Heart Block / congenital*
  • Heart Block / diagnostic imaging
  • Heart Block / mortality
  • Humans
  • Hydrops Fetalis / complications
  • Hydrops Fetalis / diagnostic imaging
  • Pregnancy
  • Pregnancy Outcome
  • Prognosis
  • Retrospective Studies
  • Survival Rate
  • Transposition of Great Vessels / complications
  • Transposition of Great Vessels / diagnostic imaging*
  • Transposition of Great Vessels / mortality
  • Ultrasonography, Prenatal / methods*