91 results on '"congenital heart block"'
Search Results
2. Congenital Complete Heart Block—To Stimulate (When?) or Not to Stimulate?
- Author
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Kukla, Piotr, Podlejska, Beata, and Wiliński, Jerzy
- Subjects
CONGENITAL heart disease diagnosis ,ORAL drug administration ,ELECTROCARDIOGRAPHY ,ATROPINE ,HEART block ,ALBUTEROL ,MEDICAL referrals ,ECHOCARDIOGRAPHY - Abstract
This article presents the case of a 27-year-old female patient with idiopathic congenital complete heart block who does not consent to the implantation of a cardiac pacemaker but was referred by her primary care physician for cardiological evaluation. The conduction disturbance was recognized at the age of 6 and was asymptomatic. The professional disqualification from pacemaker implantation included a detailed history of a patient's symptoms, an echocardiographic assessment of the heart, exercise testing and ECG Holter monitoring. The aid of salbutamol administered orally was also useful. [ABSTRACT FROM AUTHOR]
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- 2024
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- View/download PDF
3. Home monitoring of fetal heart rhythm: Lived experiences of women with anti-SSA/Ro52 autoantibodies and their co-parents.
- Author
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Tingström, Joanna, Öst, Elin, Bergman, Gunnar, and Burström, Åsa
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FETAL heart , *AUTOANTIBODIES , *HEART block , *MEDICAL personnel , *CHILDBIRTH , *CHILDBIRTH at home - Abstract
Objective: The aim of this study was to explore the parents' experiences of home monitoring of the fetal heart rhythm. Women with anti-SSA/Ro52 autoantibodies carry a 2%–3% risk of giving birth to a child with congenital heart block (CHB), following transplacental transfer and antibody-mediated inflammation in the fetal conduction system during 18th to 24th gestational week. Early detection and subsequent treatment have been reported to decrease morbidity and mortality. Therefore, home monitoring of the fetal heart rhythm by Doppler has been offered at our fetal cardiology center. This study was undertaken to explore the lived experience of the routine. Methods: Participants were recruited from a single fetal cardiology center. Consecutive sampling was used. The inclusion criteria were women with SSA/Ro52 antibodies who had undergone Doppler examinations within the last two and a half years at the hospital and had monitored the fetal heartbeat at home. A semi-structured questionnaire was created, and the participants were interviewed individually. The interviews were transcribed verbatim and analyzed according to qualitative content analysis. Results: The overall theme was defined as "walking on thin ice," with six underlying categories: reality, different strategies, gain and loss, healthcare providers, underlying tension, and conducting the examinations again, all with a focus on how to handle the home monitoring during the risk period. Conclusion: Both the mother and the co-parent expressed confidence in their own abilities and that the monitoring provided them with the advantage of growing a bond with the expected child. However, all the participants described a feeling of underlying tension during the risk period. The results show that home monitoring is not experienced as complicated or a burden for the parents-to-be and should be considered a vital part of the chain of care for mothers at risk for giving birth to a child with CHB. However, explaining the teamwork between the different caregivers, for the patients involved, their areas of expertise, and how they collaborate with the patient continues to be a pedagogic challenge and should be developed further. [ABSTRACT FROM AUTHOR]
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- 2024
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4. Molecular Mechanisms of Fetal and Neonatal Lupus: A Narrative Review of an Autoimmune Disease Transferal across the Placenta.
- Author
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Di Ludovico, Armando, Rinaldi, Marta, Mainieri, Francesca, Di Michele, Stefano, Girlando, Virginia, Ciarelli, Francesca, La Bella, Saverio, Chiarelli, Francesco, Attanasi, Marina, Mauro, Angela, Bizzi, Emanuele, Brucato, Antonio, and Breda, Luciana
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HEART block , *AUTOIMMUNE diseases , *NEONATOLOGY , *PLACENTA , *KEYWORD searching , *DISEASE management - Abstract
This study, conducted by searching keywords such as "maternal lupus", "neonatal lupus", and "congenital heart block" in databases including PubMed and Scopus, provides a detailed narrative review on fetal and neonatal lupus. Autoantibodies like anti-Ro/SSA and anti-La/SSB may cross the placenta and cause complications in neonates, such as congenital heart block (CHB). Management options involve hydroxychloroquine, which is able to counteract some of the adverse events, although the drug needs to be used carefully because of its impact on the QTc interval. Advanced pacing strategies for neonates with CHB, especially in severe forms like hydrops, are also assessed. This review emphasizes the need for interdisciplinary care by rheumatologists, obstetricians, and pediatricians in order to achieve the best maternal and neonatal health in lupus pregnancies. This multidisciplinary approach seeks to improve the outcomes and management of the disease, decreasing the burden on mothers and their infants. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
5. Dual challenge inside the womb: a case report of concomitant fetal atrio-ventricular block associated with maternal anti-SSA antibodies and fetal tachyarrhythmia diagnosed as Wolff-Parkinson-White syndrome after birth
- Author
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Ana Teodósio Chícharo, Mónica Rebelo, Ana Rita Lopes, Maria João Saavedra, Maria Filipa Paramés, Ana Rita Araújo, Ana Rita Cruz-Machado, Luísa Pinto, and Susana Capela
- Subjects
case report ,fetal atrio-ventricular block ,congenital heart block ,Wolff-Parkinson-White syndrome ,pregnancy ,anti-SSA/Ro antibodies ,Immunologic diseases. Allergy ,RC581-607 - Abstract
Fetal autoimmune atrioventricular block (AVB) is a rare but potentially life-threatening condition. It results from the passage of maternal anti-SSA/Ro or Anti SSB/La auto-antibodies into the fetal circulation, leading to inflammation and fibrosis of the AV node and often to irreversible damage. Besides AVB, these antibodies can also cause cardiomyopathies, but there is no evidence linking them to tachyarrhythmias. We present the case of a patient with significant risk factors for fetal AVB: a prior history of hydrops fetalis, high anti-SSA/Ro antibody levels and hypothyroidism. In this case, the use of dexamethasone and intravenous immunoglobulin may have contributed to reversing the first-degree atrioventricular block detected at 19 weeks of gestation. Additionally, at 21 weeks, the fetus developed a tachyarrhythmia that needed treatment with flecainide. Soon after the birth, the newborn underwent ECG Holter and Wolff-Parkinson-White Syndrome (WPWS) was diagnosed. To our knowledge, the coexistence of fetal AVB and WPWS has never been described.
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- 2024
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6. The Research Registry for Neonatal Lupus
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- 2023
7. Reverse complete heart block using transcutaneous pacing and repeated plasmapheresis in a neonate with lupus: a case report
- Author
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Yanfei Liu, Wanwei Li, Kun Zhou, and Zhangxue Hu
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Neonatal systemic Lupus Erythematosus ,Congenital heart block ,Cardiac pacing, Artificial ,Plasmapheresis ,Case report ,Pediatrics ,RJ1-570 ,Diseases of the musculoskeletal system ,RC925-935 - Abstract
Abstract Background It has been reported that the complete heart block (CHB) in neonatal lupus (NL) cannot be reversed. This study reported a case of NL-CHB that was reversed by transcutaneous pacing and repeated plasmapheresis. Case presentation A 35+ 6-week male preterm baby was transferred to the neonatal intensive care unit of the Army Medical Center in May 2020 for slight cyanosis around the lips and nose. Two days after birth, a sudden decrease in heart rate was observed during electrocardiogram (EGG) monitoring. Physical examination revealed a bluish-purple discoloration around the lips and an irregular heartbeat. EGG showed the presence of isolated P (142 bpm) and QRS (78 bpm) waves, ventricular escape beats, and a diagnosis of NL-CHB. To reverse the condition, transcutaneous pacing and five sessions of plasmapheresis were performed. At a 1.5-year follow-up, the baby exhibited well-developed cardiac structure and normal neurodevelopment. Conclusions Transcutaneous pacing and repeated plasmapheresis might be possible to reverse CHB in NL.
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- 2023
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8. Reverse complete heart block using transcutaneous pacing and repeated plasmapheresis in a neonate with lupus: a case report.
- Author
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Liu, Yanfei, Li, Wanwei, Zhou, Kun, and Hu, Zhangxue
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HEART block , *PLASMAPHERESIS , *NEONATAL intensive care units , *CYANOSIS , *PREMATURE infants , *NEWBORN infants , *HEART beat - Abstract
Background: It has been reported that the complete heart block (CHB) in neonatal lupus (NL) cannot be reversed. This study reported a case of NL-CHB that was reversed by transcutaneous pacing and repeated plasmapheresis. Case presentation: A 35+ 6-week male preterm baby was transferred to the neonatal intensive care unit of the Army Medical Center in May 2020 for slight cyanosis around the lips and nose. Two days after birth, a sudden decrease in heart rate was observed during electrocardiogram (EGG) monitoring. Physical examination revealed a bluish-purple discoloration around the lips and an irregular heartbeat. EGG showed the presence of isolated P (142 bpm) and QRS (78 bpm) waves, ventricular escape beats, and a diagnosis of NL-CHB. To reverse the condition, transcutaneous pacing and five sessions of plasmapheresis were performed. At a 1.5-year follow-up, the baby exhibited well-developed cardiac structure and normal neurodevelopment. Conclusions: Transcutaneous pacing and repeated plasmapheresis might be possible to reverse CHB in NL. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
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9. Toczeń noworodkowy - profilaktyka i leczenie. Przegląd literatury.
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Meliksetian, Astrik, Łopuszyńska, Inga, Kosecka, Katarzyna, Rudziński, Patryk, Cieślik, Aleksandra, Jargieło, Anna, Kosieradzka, Karolina, Adamowicz, Dominik, Stańczyk, Justyna, Wosińska, Alicja, and Pazik, Dorota
- Abstract
Copyright of Paediatrics & Family Medicine / Pediatria i Medycyna Rodzinna is the property of Medical Communications Sp. z o.o. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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- 2023
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10. Congenital Complete Heart Block—To Stimulate (When?) or Not to Stimulate?
- Author
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Piotr Kukla, Beata Podlejska, and Jerzy Wiliński
- Subjects
congenital heart block ,cardiac pacemaker ,atropine ,salbutamol ,Medicine - Abstract
This article presents the case of a 27-year-old female patient with idiopathic congenital complete heart block who does not consent to the implantation of a cardiac pacemaker but was referred by her primary care physician for cardiological evaluation. The conduction disturbance was recognized at the age of 6 and was asymptomatic. The professional disqualification from pacemaker implantation included a detailed history of a patient’s symptoms, an echocardiographic assessment of the heart, exercise testing and ECG Holter monitoring. The aid of salbutamol administered orally was also useful.
- Published
- 2024
- Full Text
- View/download PDF
11. Molecular Mechanisms of Fetal and Neonatal Lupus: A Narrative Review of an Autoimmune Disease Transferal across the Placenta
- Author
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Armando Di Ludovico, Marta Rinaldi, Francesca Mainieri, Stefano Di Michele, Virginia Girlando, Francesca Ciarelli, Saverio La Bella, Francesco Chiarelli, Marina Attanasi, Angela Mauro, Emanuele Bizzi, Antonio Brucato, and Luciana Breda
- Subjects
neonatal lupus erythematosus ,congenital heart block ,autoantibodies ,Biology (General) ,QH301-705.5 ,Chemistry ,QD1-999 - Abstract
This study, conducted by searching keywords such as “maternal lupus”, “neonatal lupus”, and “congenital heart block” in databases including PubMed and Scopus, provides a detailed narrative review on fetal and neonatal lupus. Autoantibodies like anti-Ro/SSA and anti-La/SSB may cross the placenta and cause complications in neonates, such as congenital heart block (CHB). Management options involve hydroxychloroquine, which is able to counteract some of the adverse events, although the drug needs to be used carefully because of its impact on the QTc interval. Advanced pacing strategies for neonates with CHB, especially in severe forms like hydrops, are also assessed. This review emphasizes the need for interdisciplinary care by rheumatologists, obstetricians, and pediatricians in order to achieve the best maternal and neonatal health in lupus pregnancies. This multidisciplinary approach seeks to improve the outcomes and management of the disease, decreasing the burden on mothers and their infants.
- Published
- 2024
- Full Text
- View/download PDF
12. Identifying Congenital Heart Block in Primary Care.
- Author
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Flowers, Mary Elizabeth, Garber, Kelli, and Temples, Heide S.
- Abstract
• A common cause of congenital heart block is autoimmune in mothers with lupus. • Symptoms range in severity going from asymptomatic to syncope and cyanosis. • Congenital heart block may occur in a structurally normal heart. • Research focused on preventing fetal heart effects in pregnant women with lupus. Congenital heart block is a rare disease characterized by electrical conduction abnormalities of the heart in patients with both structural and without structural abnormalities. The most common cause of congenital heart block is autoimmune related, but other potential causes exist. Treatment for congenital heart block is determined by the severity of the disease and presenting symptoms. Primary care providers are in the optimal position to support patients and families. Although common causes and treatments of congenital heart block are known, much research is still to be done on the cause, optimal treatments, and potential long-term side effects. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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13. Percutaneous extraction of a protruding atrial pacing lead in an 8-year-old child.
- Author
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Dalili, Mohammad, Ariannia, Ali, and Rezanejad, Elham
- Abstract
An 8-year-old girl with a history of single-chamber epicardial pacemaker during infancy and cardiac resynchronization therapy with a His bundle pacing lead implantation six months earlier, presented with congenital complete heart block. At the follow-up visit, we found atrial pacing lead protrusion with probable insulation in the computed tomography scan. We have shown late pacemaker lead perforation management under fluoroscopic guidance in a pediatric patient. A serious complication associated with cardiac implantable electronic devices is lead perforation. In the pediatric age group, limited data exist on this complication and its challenging management. We present a case of atrial pacing lead protrusion in an 8-year-old girl. The lead was extracted under fluoroscopic guidance without any complications. [ABSTRACT FROM AUTHOR]
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- 2023
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14. Ventricular Functional Analysis in Congenital Complete Heart Block Using Speckle Tracking: Left Ventricular Epicardial Compared to Right Ventricular Septal Pacing.
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Torpoco Rivera, Diana Milagros, Sriram, Chenni, Karpawich, Peter P., and Aggarwal, Sanjeev
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SPECKLE tracking echocardiography , *HEART block , *FUNCTIONAL analysis , *SPECKLE interference , *VENTRICULAR ejection fraction , *CARDIAC patients - Abstract
Background: Chronic right ventricular (RV) apical pacing in patients with congenital complete atrioventricular block (CCAVB) is associated with left ventricle (LV) dyssynchrony and dysfunction. Hence, alternative pacing sites are advocated. The aim of this study was to compare LV function using STE in selected patients with LV epicardial pacing (LVEp) vs. RV transvenous pacing (RVSp). Methods: This was a single-center, retrospective study in patients with CCAVB who underwent permanent pacemaker implant at age ≤ 18 years. Age- and gender-matched patients with a normal heart anatomy and function served as the control group. LV function was comprehensively assessed by conventional 2D Echocardiography and speckle-tracking echocardiography (STE). Results: We included 24 patients in the pacemaker group [27.6% male, mean age of 17.1 at last follow-up, follow-up duration of 8.7 years, RVSp (n = 9; 62.5%)] compared to 48 matched healthy controls. Shortening fraction (SF) and ejection fraction (EF) were normal and similar between cases and controls. However, STE detected abnormal LV function in the pacemaker group compared to controls. The former demonstrated lower/abnormal, Peak Longitudinal Strain myocardial (PLS Myo) [− 12.0 ± 3.3 vs. − 18.1 ± 1.9, p < 0.001] and Peak Longitudinal Strain endocardial (PLS endo) [− 16.1 ± 4.1 vs. 1.7 ± 1.7, p < 0.001]. STE parameters of LV function were significantly more abnormal in LVEp vs. RVSp subgroup as demonstrated by lower values for PLS Myo (− 10.1 ± 3.2 vs. − 13.1 ± 2.9, p = 0.03) and PLS Endo (− 13.8 ± 4.4 vs. − 17.5 ± 3.3, p = 0.03). Conclusion: STE was more sensitive in detecting subtle differences in LV function relative to standard conventional 2D echocardiography (SF and EF) in selected patients with CCAVB and a permanent pacemaker. Furthermore, STE demonstrated that transvenous RV septal pacing was associated with better LV systolic function preservation than LV epicardial pacing for comparable post-implant intervals. [ABSTRACT FROM AUTHOR]
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- 2023
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15. Plasmapheresis in Neonatal Lupus
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Mark Sharobim, Angelica S. J. Scribner, and William N. Rose
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Sjögren syndrome ,cardiac neonatal lupus ,systemic lupus erythematosus ,congenital heart block ,plasmapheresis ,Immunologic diseases. Allergy ,RC581-607 - Abstract
About 2% of mothers with Sjögren’s syndrome and about 1% of mothers with systemic lupus erythematosus deliver a baby with a congenital heart block (CHB). This is thought to be as a result of the maternal autoantibodies that cross the placenta and cause congenital lupus in the fetus/neonate. Among patients with a 2nd or 3rd degree atrioventricular block, the mortality rate in the neonatal period is about 10%, and most neonates who survive require a pacemaker into adulthood. Despite the compelling mortality and morbidity, the data on the optimal preventive treatments are meager and not well-established. In addition to pharmaceutical therapy, one potentially effective therapy is plasmapheresis. Plasmapheresis is safe in pregnancy, well tolerated, and is effective in removing the offending substances in the serum which may cause disease. We review this literature, in order to educate the reader and to motivate interest in studying this condition in the future.
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- 2022
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16. Neonatal lupus erythematosus – prevention is better than cure
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Agata Liszewska and Anna Woźniacka
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neonatal lupus erythematosus ,congenital heart block ,antinuclear antibodies ,anti-ro/ssa antibodies ,anti-la/ssb antibodies ,Dermatology ,RL1-803 ,Internal medicine ,RC31-1245 - Abstract
Neonatal lupus erythematosus (NLE) is a congenital autoimmune condition in which the transplacental passage of immunoglobulin G (IgG) directed against auto-antigens causes clinical symptoms in the foetus or neonate. Anti-Ro/SS-A, anti-La/SS-B, and to a lesser extent, anti-U1RNP autoantibodies (aAbs) have the strongest association with NLE. However, ~ 50% of affected mothers are asymptomatic despite carrying those aAbs. The clinical picture of the disease is very diverse. Cardiac manifestations are the most severe, including congenital heart block (CHB), with a mortality rate of ~18%. Preventative therapy with hydroxychloroquine (HCQ) reduces the recurrence rate of CHB in subsequent pregnancies by ~50%.
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- 2022
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17. Case report: Challenges and implications of conduction system pacing in pediatrics: Case series
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Ruy Gonzalo Ploneda Valencia, Moisés Levinstein Jacinto, Carmen A. Sánchez Contreras, Gustavo Ruiz González, Diego Neach de la Vega, Manlio F. Márquez Murillo, and Santiago Nava
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children ,pacemaker ,physiological stimulation ,His bundle pacing ,left bundle branch pacing ,congenital heart block ,Pediatrics ,RJ1-570 - Abstract
Cardiac electrical stimulation in children usually is needed in the setting of complete congenital atrioventricular block, atrioventricular block after heart surgery, and bradycardia associated with some specific channelopathies. In cases of atrioventricular block, the high percentage of ventricular stimulation raises concern on the deleterious effects of chronic stimulation of the right ventricle. In recent years, physiologic stimulation has developed as a valid approach for adult patients and a great interest has risen in offering conduction system pacing also to the pediatric population. We present three pediatric cases of stimulation of the conduction system (His bundle or left bundle branch), in order to show the intrinsic particularities and challenges implied in these new techniques.
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- 2023
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18. Autoimmune Congenital Complete Heart Block: How Late Can It Occur?
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Luv Makadia, Peter Izmirly, Jill P. Buyon, and Colin K. L. Phoon
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neonatal lupus ,fetal echocardiography ,congenital heart block ,complete heart block ,Gynecology and obstetrics ,RG1-991 - Abstract
Objective Maternal anti-Ro (SSA) and/or anti-La (SSB) antibodies are a risk factor for congenital complete heart block (CHB). Because detailed analysis of the incidence of CHB after 24 weeks of gestational age (GA) is lacking, we aimed to ascertain the risk of “later-onset” CHB among offspring of SSA/SSB-positive mothers in the published literature. Study Design Using search terms “neonatal lupus heart block” and “autoimmune congenital heart block” on PubMed and Ovid, we gathered prospective studies of SSA/SSB-positive mothers with fetal echo surveillance starting from before CHB diagnosis and retrospective cases of fetal CHB diagnosis after 24 weeks of GA (if there was prior normal heart rate) or after birth. Results Ten prospective studies included 1,248 SSA/SSB-positive pregnancies with 24 cases of CHB diagnosed during pregnancy (1.9%). Among these, three (12.5%) were after 24 weeks—at weeks 25, 26, and 28. Our retrospective studies revealed 50 patients with CHB diagnosis in late fetal life and neonatal period and 34 in the nonneonatal childhood period. An additional four cases were diagnosed after age 18 years. Conclusion Later-onset autoimmune CHB in offspring of SSA/SSB-positive mothers does occur. Our analysis suggests that prenatal surveillance should continue beyond 24 weeks of GA but is limited by inconsistent published surveillance data.
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- 2023
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19. NAFTNet retrospective report on the treatment of anti-Ro/SSA mediated fetal heart block with dexamethasone.
- Author
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Sunderji, Sherzana, Peyvandi, Shabnam, Jaeggi, Edgar, Szwast, Anita, Ryan, Greg, Tessier, Francine, Siddiqui, Saad, Cuneo, Bettina, Sheth, Shreya, Treadwell, Marjorie, Frommelt, Michele, Turan, Shifa, Copel, Joshua, Emery, Stephen, Rand, Larry, and Moon-Grady, Anita J.
- Subjects
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FETAL heart , *HEART block , *FETAL diseases , *PREGNANCY complications , *PREGNANCY outcomes , *PREMATURE labor - Abstract
Background: Complete atrioventricular block (CAVB) is a complication of maternal antibody positivity and treatment of fetal disease is controversial in terms of efficacy and safety. We hypothesized that dexamethasone treatment for fetal anti-Ro/SSA antibody-mediated cardiac disease leads to better pregnancy outcomes than expectant management. Methods: A retrospective multi-center cohort study of anti-Ro/SSA antibody positive pregnancies with fetal conduction disease reported by participating North American Fetal Therapy Network (NAFTNet) centers between January 2010 and December 2018. The primary outcomes included: fetal death, oligohydramnios, growth restriction, preterm delivery, and new maternal comorbidities. Secondary outcomes included: pacemaker prior to 28 days, transplantation, and neonatal death in maternal/fetal dyads treated with dexamethasone versus not. Results: In 127 anti-Ro/SSA positive pregnancies, 98 were treated with dexamethasone and 29 were not. Of those treated, 61/96 (63.5%) met the primary outcome including 45/91 (49.4%) premature deliveries; 20 mothers developed comorbidities during treatment (fetal death 5, 10 growth restriction, 14 oligohydramnios, two new/worsening gestational diabetes). In the untreated group, 15/25 (60%) met the primary outcome including 11/22 (50%) premature deliveries and four mothers developing comorbidities during their pregnancy (fetal death 3, one growth restriction, one new onset maternal hypertension). Regarding secondary outcomes, 37/ 96 (43%) treated fetuses required a pacemaker or died by 28 days, while untreated 13/25 (52%) required pacemaker placement, died prior to 28 days or required listing for transplantation. Excluding terminations, survival without transplant was 17 (68%) in untreated and 85 (89%) in treated patients (p<.01). Conclusions: While the use of dexamethasone in anti-Ro/SSA positive pregnancies is associated with a high rate of poor pregnancy outcomes, there was an unexpected similarly high rate in untreated positive pregnancies. This suggests that the maternal disease itself is influencing pregnancy complications independent of dexamethasone. Our data, which show that treatment decreases neonatal morbidity and overall mortality without increasing overall pregnancy complications, warrant further study. [ABSTRACT FROM AUTHOR]
- Published
- 2022
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20. Neonatal lupus erythematosus - prevention is better than cure.
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Liszewska, Agata and Woźniacka, Anna
- Subjects
- *
AUTOANTIBODIES , *OPERATIVE surgery , *MORTALITY , *HYDROXYCHLOROQUINE , *NEWBORN infants - Abstract
Neonatal lupus erythematosus (NLE) is a congenital autoimmune condition in which the transplacental passage of immunoglobulin G (IgG) directed against auto-antigens causes clinical symptoms in the foetus or neonate. Anti-Ro/SS-A, anti-La/SS-B, and to a lesser extent, anti-U1RNP autoantibodies (aAbs) have the strongest association with NLE. However, ~ 50% of affected mothers are asymptomatic despite carrying those aAbs. The clinical picture of the disease is very diverse. Cardiac manifestations are the most severe, including congenital heart block (CHB), with a mortality rate of ~18%. Preventative therapy with hydroxychloroquine (HCQ) reduces the recurrence rate of CHB in subsequent pregnancies by ~50%. [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
- View/download PDF
21. Health Outcomes of 215 Mothers of Children With Autoimmune Congenital Heart Block: Analysis of the French Neonatal Lupus Syndrome Registry.
- Author
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Miniaoui, Imene, Morel, Nathalie, Lévesque, Kateri, Maltret, Alice, Driessen, Marine, Masseau, Agathe, Orquevaux, Pauline, Piette, Jean-Charles, Barriere, Francois, Le Bidois, Jérome, Georgin-Lavialle, Sophie, Guettrot-Imbert, Gaëlle, Le Guern, Véronique, Mouthon, Luc, Jallouli, Moez, Deligny, Christophe, Hachulla, Eric, Romefort, Bénédicte, Bonnet, Damien, and Costedoat-Chalumeau, Nathalie
- Subjects
SYSTEMIC lupus erythematosus diagnosis ,AUTOIMMUNE diseases ,ACQUISITION of data ,RETROSPECTIVE studies - Abstract
Objective: Transplacental passage of maternal anti-SSA and anti-SSB antibodies, potentially associated with maternal autoimmune diseases, can cause neonatal lupus syndrome. Given the paucity of data in this setting, we report short- and long-term outcomes of mothers of offspring with congenital heart block (CHB).Methods: This retrospective study included anti-SSA/SSB antibody-positive mothers of fetuses with high-degree CHB and focused on their health status before pregnancy, at CHB diagnosis, and thereafter.Results: We analyzed 215 women with at least 1 pregnancy with CHB. Prior to this diagnosis, only 52 (24%) mothers had been diagnosed with an autoimmune disease, mainly systemic lupus erythematosus (SLE; n = 26, 12%) and Sjögren syndrome (SS; n = 16, 7%). Six more were diagnosed with an autoimmune disease during the index pregnancy. Of the 157 mothers (73%) with no such diagnosis at childbirth, 77 (49%) developed one after a median follow-up of 11 years (range: 21 days to 54 years). By the end of follow-up, 135 women (63%) had an autoimmune disease diagnosis, mainly SLE (n = 54, 25%) and SS (n = 72, 33%). Three patients with SLE had renal involvement, and only 6 (3%) had required an immunosuppressive drug at any point. The symptoms best predicting autoimmune disease development were arthralgia and myalgia (P < 0.001), dry syndrome (P = 0.01), and parotid swelling (P = 0.05).Conclusion: One-quarter of the patients had an autoimmune disease diagnosis at the time of the fetal CHB diagnosis. Nearly half of those without an initial diagnosis progressed during follow-up, most without severe manifestations. Severe diseases such as lupus nephritis were rarely seen, and immunosuppressive drugs were rarely required. [ABSTRACT FROM AUTHOR]- Published
- 2022
- Full Text
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22. Recurrent Congenital Heart Block Due to Maternal Anti-Ro Antibodies: Successful Prevention of Poor Pregnancy Outcome with Hydroxychloroquine and Added Dexamethasone
- Author
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Brindusa Cimpoca-Raptis, Anca Marina Ciobanu, Nicolae Gica, Ana Maria Scutelnicu, Alexandra Bouariu, Mihaela Popescu, and Anca Maria Panaitescu
- Subjects
anti-Ro antibodies ,congenital heart block ,transplacental antibodies passage ,hydroxychloroquine ,Reproduction ,QH471-489 - Abstract
Autoimmune Congenital Heart Block (CHB) is an immune-mediated disease caused by transplacental passage of maternal circulating anti-Ro/SSA and anti-La/SSB antibodies which can bind to fetal cardiac tissue, damaging conduction tissues by inflammation and fibrosis. Approximately 2% of pregnancies with positive anti-Ro antibodies will be complicated by fetal atrioventricular block and the risk of recurrence in subsequent pregnancies is 10 times higher. We report a case of a clinically asymptomatic patient diagnosed with anti-Ro antibodies who had two pregnancies complicated by CHB with different outcomes. Despite preventive treatment with hydroxychloroquine (HCQ) from 6 weeks of pregnancy onward, the fetus developed second to third degree CHB. Dexamethasone was added. The pregnancy evolved to near-term with persistent intermittent CHB. It is not clear how pregnancies with recurrent fetal CHB despite prophylaxis with HCQ should be managed and there is a need for controlled studies to answer the remaining questions in relation to this subject.
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- 2022
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23. Management of fetal congenital heart block in pregnancies with anti-Ro antibodies
- Author
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Anca Maria Panaitescu, Gheorghe Peltecu, and Nicolae Gica
- Subjects
fetus ,pregnancy ,congenital heart block ,anti-ro antibodies ,Medicine ,Immunologic diseases. Allergy ,RC581-607 - Abstract
Anti-Ro antibodies are detected frequently in the general population, but more so in patients with autoimmune conditions as Sjögren’s syndrome and systemic lupus erythematous (SLE). During pregnancy, anti-Ro antibodies can cross the placenta by hijacking physiological mechanisms and can have deleterious effects on the fetus. Administration of hydroxychloroquine (HCQ) to pregnant women with documented anti-Ro antibodies has been shown to prevent congenital heart block (CHB ). Serial fetal ultrasound scans and echocardiograms are controversial in pregnant women with anti-Ro antibodies. When complete CHB is diagnosed, this is irreversible and can lead to fetal heart failure, hydrops, and death. After delivery, babies with complete CHB require pacemaker. In the presence of maternal anti-Ro antibodies, there is a high risk of recurrence of CHB for future pregnancies, if there is a previously affected child. Adequate counselling and prophylactic treatment with HCQ should be encouraged.
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- 2021
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24. Fetal Arrhythmia Diagnosis and Pharmacologic Management.
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Strasburger, Janette F., Eckstein, Gretchen, Butler, Mary, Noffke, Patrick, and Wacker‐Gussmann, Annette
- Subjects
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ARRHYTHMIA diagnosis , *MYOCARDIAL depressants , *ECHOCARDIOGRAPHY , *BUNDLE-branch block , *LONG QT syndrome , *CONGENITAL heart disease , *VENTRICULAR tachycardia , *HEART block , *HEART function tests , *TACHYCARDIA , *ARRHYTHMIA , *FETUS - Abstract
One of the most successful achievements of fetal intervention is the pharmacologic management of fetal arrhythmias. This management usually takes place during the second or third trimester. While most arrhythmias in the fetus are benign, both tachy‐ and bradyarrhythmias can lead to fetal hydrops or cardiac dysfunction and require treatment under certain conditions. This review will highlight precise diagnosis by fetal echocardiography and magnetocardiography, the 2 primary means of diagnosing fetuses with arrhythmia. Additionally, transient or hidden arrhythmias such as bundle branch block, QT prolongation, and torsades de pointes, which can lead to cardiomyopathy and sudden unexplained death in the fetus, may also need pharmacologic treatment. The review will address the types of drug therapies; current knowledge of drug usage, efficacy, and precautions; and the transition to neonatal treatments when indicated. Finally, we will highlight new assessments, including the role of the nurse in the care of fetal arrhythmias. The prognosis for the human fetus with arrhythmias continues to improve as we expand our ability to provide intensive care unit–like monitoring, to better understand drug treatments, to optimize subsequent pregnancy monitoring, to effectively predict timing for delivery, and to follow up these conditions into the neonatal period and into childhood. Coordinated initiatives that facilitate clinical fetal research are needed to address gaps in knowledge and to facilitate fetal drug and device development. [ABSTRACT FROM AUTHOR]
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- 2022
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25. Fetal and Maternal Outcomes in a Cohort of Patients With Primary Sjogren's Syndrome: An Observational Study.
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Paladugu V, Teja N, Menon R, and Ramachandran R
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Background Pregnant women with primary Sjogren's syndrome (PSS) have a high incidence of maternal and fetal complications due to immunological variations caused by maternal antibodies (anti-Sjogren's-syndrome-related antigen A (SSA) and anti-anti-Sjogren's-syndrome-related antigen B (SSB) crossing the placenta from the 12th week of gestation, mediating the tissue damage. A multidisciplinary approach is required in the management of such patients. Data regarding the effects of PSS on pregnancy are deficient in the Indian context. Methods This was a retrospective observational study on the maternal and fetal outcomes of PSS on a cohort of pregnant women treated at our tertiary care center between 2011 and 2020. Patients who satisfied the criteria for PSS were included, and patients with other associated autoimmune disorders were excluded. Maternal age, number of miscarriages, prior obstetric history, and maternal and fetal complications were recorded and statistically analyzed. Results There were 16 pregnancies in 10 women with PSS (incidence: 1/1,000 pregnancies/year) in our study. The mean gestational age of the mother at presentation was 31 ± 9.0 weeks. Oligohydramnios in five (11.8), intrauterine fetal demise (IUFD) in two (11.8), and first-trimester medical termination of pregnancy (MTP) in four (23.5) were noted. The weight of neonates was 2.3 ± 0.8 kg, and the mean duration of neonatal intensive care (NICU) stay was seven days. Fetal echo revealed congenital heart block (CHB), with six (50.0%) complete and one (8.3%) incomplete (p = 0.004). One baby needed a permanent pacemaker. Conclusion Maternal and fetal complications are high in our set of mothers with PSS. Early detection, regular follow-up, and a multidisciplinary approach may improve the outcome., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Ethics Committee Amrita School of Medicine issued approval ECASM-AIMS-2021-349. Ethical clearance is hereby issued to this study. The PI shall submit a copy of the completed study for the records. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Paladugu et al.)
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- 2024
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26. Dual challenge inside the womb: a case report of concomitant fetal atrio-ventricular block associated with maternal anti-SSA antibodies and fetal tachyarrhythmia diagnosed as Wolff-Parkinson-White syndrome after birth.
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Chícharo AT, Rebelo M, Lopes AR, Saavedra MJ, Paramés MF, Araújo AR, Cruz-Machado AR, Pinto L, and Capela S
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- Humans, Female, Pregnancy, Adult, Infant, Newborn, Fetal Diseases diagnosis, Fetal Diseases immunology, Immunoglobulins, Intravenous therapeutic use, Antibodies, Antinuclear blood, Antibodies, Antinuclear immunology, Wolff-Parkinson-White Syndrome diagnosis, Wolff-Parkinson-White Syndrome immunology, Tachycardia diagnosis, Tachycardia etiology, Atrioventricular Block diagnosis, Atrioventricular Block immunology, Atrioventricular Block etiology
- Abstract
Fetal autoimmune atrioventricular block (AVB) is a rare but potentially life-threatening condition. It results from the passage of maternal anti-SSA/Ro or Anti SSB/La auto-antibodies into the fetal circulation, leading to inflammation and fibrosis of the AV node and often to irreversible damage. Besides AVB, these antibodies can also cause cardiomyopathies, but there is no evidence linking them to tachyarrhythmias. We present the case of a patient with significant risk factors for fetal AVB: a prior history of hydrops fetalis , high anti-SSA/Ro antibody levels and hypothyroidism. In this case, the use of dexamethasone and intravenous immunoglobulin may have contributed to reversing the first-degree atrioventricular block detected at 19 weeks of gestation. Additionally, at 21 weeks, the fetus developed a tachyarrhythmia that needed treatment with flecainide. Soon after the birth, the newborn underwent ECG Holter and Wolff-Parkinson-White Syndrome (WPWS) was diagnosed. To our knowledge, the coexistence of fetal AVB and WPWS has never been described., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Chícharo, Rebelo, Lopes, Saavedra, Paramés, Araújo, Cruz-Machado, Pinto and Capela.)
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- 2024
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27. Simple surgical technique for epicardial pacemaker wire preparation and insertion
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Amit Mishra, Kartik Patel, Chandrasekaran Ananthanarayananh, Vivek Wadhawa, and Himani Pandya
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congenital heart block ,epicardial pacing wires ,temporary pacing wire ,Medicine ,Surgery ,RD1-811 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Epicardial pacing wire (EPW) insertion is an integral part of open heart surgery. However, the use of EPW insertion is also associated with complications such as bleeding, tamponade, arrhythmias, and occasionally even death of the patient. Various techniques have been described for preparing, placing, and removing EPW. We present our simple, yet effective technique of preparing, inserting, and removing EPW where the incidence of complications is nil.
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- 2022
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28. Rare Case of Congenital Heart Block in a Retrospectively Diagnosed Case of Sjögren's Syndrome in Mother: A Case Report.
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Taneja, Nikhil, Mane, Shailaja, Malwade, Sudhir, Poduri, Sravya, Pathak, Nakul, Khot, Nikita, and Agarkhedkar, Sharad
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- *
HEART block , *SJOGREN'S syndrome , *NEONATAL intensive care units , *FATIGUE (Physiology) , *MOTHERS , *RHEUMATISM - Abstract
Sjögren's (SHOW'-grenz) syndrome is a systemic autoimmune, rheumatic disease that affects the entire body. The most common problems are dry mouth, dry eyes, fatigue and musculoskeletal pain in adults. Ten times as many women as men are diagnosed with Sjögren's. While most often diagnosed in women during middle age or after menopause. The congenital heart block (CHB) is defined as the heart block that is diagnosed in fetus (in utero) or within the first 28 days after birth (neonatal period). Congenital heart block is a rare disorder that appears to affect males and females in equal numbers. The most common cause of congenital heart block (CHB) is neonatal lupus due to maternal Sjögren's syndrome, an acquired autoimmune disease caused by transplacental transfer of maternal antibodies to the fetus. Several studies have reported an increased rate of spontaneous abortion and fetal loss associated with Sjögren syndrome. Congenital heart block occurs in a frequency of 1 in 20,000 live births. It has been reported to occur in 2% of Ro-positive mothers [2]; 5% of mothers with a diagnosis of mixed connective tissue and/or Sjögren Syndrome [3] and in 8% of Ro-positive mothers. Here we present an early pre-term neonate that was admitted to neonatal intensive care unit for bradycardia with stable haemodynamics. The mother, who showed no clinical symptoms or any particular history, was transferred to our tertiary centre for profound fetal bradycardia on recent scans. At birth, the infant's ECG showed a third-degree atrioventricular block and echocardiography was normal. Cardiac neonatal lupus was confirmed with positive maternal anti-Ro antibodies. Under close monitoring, the infant tolerated the bradycardia well (median 72 beats per minute (bpm)) and was discharged on day 21 of life. There was no indication for pacemaker at discharge, but he would be on regular follow-up with a paediatric cardiologist. [ABSTRACT FROM AUTHOR]
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- 2023
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29. Rare complications of Sjögren’s syndrome in a female patient
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Tin Rosan, Jana Jelenić, and Marija Bakula
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central nervous system ,congenital heart block ,Sjögren’s syndrome ,SSA-antibodies ,Medicine (General) ,R5-920 - Abstract
Sjögren’s syndrome (SjS) is a systemic autoimmune disease, most common in middle-aged women, characterized by chronic inflammation of exocrine glands. It can present by itself or alongside other autoimmune diseases. Main symptoms are dry eyes and mouth, but the disease can affect joints, lungs, kidneys, peripheral nervous system (PNS), and rarely central nervous system (CNS). SS-A antibodies in SjS can pass the fetoplacental barrier and cause congenital heart block. Patients with SjS are at higher risk of developing lymphoma.
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- 2023
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30. Cohort study of congenital complete heart block among preterm neonates: a single-center experience over a 15-year period.
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Hernstadt, Hayley, Regan, William, Bhatt, Hitarth, Rosenthal, Eric, and Meau-Petit, Virginie
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EVALUATION of medical care , *NEONATAL necrotizing enterocolitis , *SCIENTIFIC observation , *NEONATAL intensive care , *CEREBRAL hemorrhage , *BRAIN diseases , *LUNG diseases , *CONGENITAL heart disease , *TERTIARY care , *NEONATAL intensive care units , *HEART block , *COMPARATIVE studies , *ARTIFICIAL respiration , *CARDIAC pacemakers , *LONGITUDINAL method , *COMORBIDITY , *DISEASE complications , *CHILDREN - Abstract
Congenital complete heart block (CCHB) is a very rare condition, with high risk of mortality. Prematurity is associated with immaturity of the cardiovascular system. Morbidity related to CCHB and prematurity has never been described. We describe a tertiary perinatal center experience over a 15-year period on CCHB management and complications in preterm infants. This is a single-center observational cohort study. All neonates admitted to neonatal intensive care unit with a diagnosis of isolated CCHB between January 2006 and January 2021 were identified. All preterm neonates (< 37 weeks) were compared with a control cohort of term neonates (≥ 37 weeks). Antenatal data, complications of prematurity, medical, and surgical management of CCHB were recorded. Twenty-four neonates with isolated CCHB (16 preterm and 8 term) were born during the study period, including 5 very preterm (< 32 weeks) and 11 preterm (32 to 37 weeks). All very preterm were born via emergency caesarian section without antenatal steroid administration. They had multiple severe morbidities including chronic lung disease, necrotizing enterocolitis, grades 3–4 intraventricular hemorrhage, cystic periventricular leukomalacia, and longer periods of mechanical and non-invasive ventilatory support than preterm. Thirteen out of sixteen preterm infants had permanent pacemakers inserted, compared to 1/8 for term newborns. All babies born before 35-week gestation were either paced or died. Conclusion: Premature neonates with CCHB have high risk of mortality and morbidity especially if undiagnosed and born by unnecessary emergency caesarian section without antenatal steroids. Prematurity below 35 weeks may be associated with death or pacemaker insertion. This supports better antenatal screening to avoid induced prematurity. What is Known: • Congenital complete heart block is a very rare condition associated with high morbidity and mortality. • Antenatal risk factors for poor outcome include fetal hydrops, low ventricular rate (HR <55 beats per minute), and congenital heart defect. What is New: • Infants born <32 weeks with CCHB had no antenatal steroid administration, and sustained high burden of morbidity (chronic lung disease, intraventricular hemorrhage, and cystic periventricular leukomalacia). • Birth <35 weeks is strongly associated with requiring pacing prior to discharge or death. [ABSTRACT FROM AUTHOR]
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- 2022
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31. Third Trimester Fetal Heart Rates in Antibody-Mediated Complete Heart Block Predict Need for Neonatal Pacemaker Placement.
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Pick, Justin, Silka, Michael J., Bar-Cohen, Yaniv, Hill, Allison, Shwayder, Mark, Wood, John, and Pruetz, Jay D.
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HEART block , *FETAL heart rate , *MEDICAL record databases , *HEART beat , *CHILDREN'S hospitals , *BIRTH weight - Abstract
Congenital complete heart block (CCHB) affects 1 in 20,000 newborns. This study evaluates fetal and neonatal risk factors predictive of neonatal pacemaker placement in antibody-mediated complete heart block. The Children's Hospital Los Angeles institutional fetal, pacemaker, and medical record databases were queried for confirmed SSA/SSB cases of CCHB between January 2004 and July 2019. Cases excluded were those with a diagnosis beyond the neonatal period, diagnosis of a channelopathy, or if maternal antibody status was unknown. We recorded the gestational age (GA), birth weight (BW), fetal heart rates (FHRs) of the last echocardiogram before delivery, specific neonatal ECG and echocardiogram findings, age at pacemaker placement, and mortality. Of 43 neonates identified with CCHB, 27 had confirmed maternal antibody exposure. Variables associated with neonatal pacemaker implantation were FHRs < 50 bpm (p = 0.005), neonatal heart rates < 52 bpm (p = 0.015), and neonatal left ventricular fractional shortening (FS) percentages < 34% (p = 0.03). On multivariate analysis, FHR remained significant (p = 0.03) and demonstrated an increased risk of neonatal pacemaker placement by an odds ratio of 12.5 (95% CI 1.3–116, p = 0.05). The median GA at which the FHR was obtained was 34 weeks (IQR 26–35 weeks). Neonatal pacemaker placement was highly associated with a FHR < 50 bpm, neonatal HR < 52 bpm, and neonatal FS < 34%. FHRs at 34 weeks GA (IQR 26–35 weeks) correlated well with postnatal heart rates and were predictive of neonatal pacemaker placement. [ABSTRACT FROM AUTHOR]
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- 2022
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32. Congenital Heart Block.
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Steinberg, Leonard
- Abstract
Congenital complete heart block (CCHB) defines atrioventricular conduction abnormalities diagnosed in utero or within the first 27 days of life. Maternal autoimmune disease and congenital heart defects are most commonly responsible. Recent genetic discoveries have highlighted our understanding of the underlying mechanism. Hydroxychloroquine shows promise in preventing autoimmune CCHB. Patients may develop symptomatic bradycardia and cardiomyopathy. The presence of these and other specific findings warrants placement of a permanent pacemaker to relieve symptoms and prevent catastrophic events. The mechanisms, natural history, evaluation, and treatment of patients with or at risk for CCHB are reviewed. [ABSTRACT FROM AUTHOR]
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- 2021
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33. Ventricular pacing and myocardial function in patient with congenital heart block.
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Rangavajla, Gautam, Mulukutla, Suresh, Thoma, Floyd, Kancharla, Krishna, Bhonsale, Aditya, Estes, N. A. Mark, Jain, Sandeep K., and Saba, Samir
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- *
VENTRICULAR ejection fraction , *CARDIOMYOPATHIES , *CONGENITAL heart disease , *RETROSPECTIVE studies , *HEART block , *CARDIAC pacing , *KAPLAN-Meier estimator , *LONGITUDINAL method - Abstract
Introduction: Pacing‐induced cardiomyopathy (PICM) is a potential complication of chronic right ventricular (RV) pacing, but its characterization in adult patients is often complicated by pre‐existing cardiomyopathy. This study investigated the incidence of PICM in patients with congenital heart block (cHB) who have conduction disease from birth without confounding pre‐existing cardiac conditions. Methods and Results: This retrospective cohort analysis included 42 patients with cHB and baseline left ventricular ejection fraction (LVEF) ≥50%. Kaplan–Meier analysis was used to assess freedom from cardiomyopathy (defined as LVEF <50%) between paced and nonpaced patients. Patients were 26 ± 3 years old at first presentation, 64% were women and baseline LVEF was 60.0 ± 0.2%. Median follow‐up from birth was 35 (interquartile range [IQR]: 20–42) years with a median of 6.7 years (IQR: 3.6–9.2) at our institution. Thirty‐two patients received pacing at mean age 21 ± 3 years. Patients receiving a pacemaker (PM) were significantly more likely to develop a cardiomyopathy (p =.021) and no patient developed a cardiomyopathy in the absence of a PM. Four patients who developed a new cardiomyopathy were upgraded to biventricular pacing, leading to stabilization or improvement of LVEF. Conclusion: In a relatively young and healthy cHB cohort, RV pacing is associated with a higher risk of developing a cardiomyopathy. These data confirm the deleterious effects of RV pacing on myocardial function in patients without pre‐existing structural cardiac disease and has clinical implications to the management of patients with cHB. [ABSTRACT FROM AUTHOR]
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- 2021
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34. Management of fetal congenital heart block in pregnancies with anti-Ro antibodies.
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Panaitescu, Anca Maria, Peltecu, Gheorghe, and Gică, Nicolae
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HEART block , *FETAL heart , *SJOGREN'S syndrome , *PHYSIOLOGY , *IMMUNOGLOBULINS , *FETAL ultrasonic imaging - Abstract
Anti-Ro antibodies are detected frequently in the general population, but more so in patients with autoimmune conditions as Sjögren’s syndrome and systemic lupus erythematous (SLE). During pregnancy, anti-Ro antibodies can cross the placenta by hijacking physiological mechanisms and can have deleterious effects on the fetus. Administration of hydroxychloroquine (HCQ) to pregnant women with documented anti-Ro antibodies has been shown to prevent congenital heart block (CHB ). Serial fetal ultrasound scans and echocardiograms are controversial in pregnant women with anti-Ro antibodies. When complete CHB is diagnosed, this is irreversible and can lead to fetal heart failure, hydrops, and death. After delivery, babies with complete CHB require pacemaker. In the presence of maternal anti-Ro antibodies, there is a high risk of recurrence of CHB for future pregnancies, if there is a previously affected child. Adequate counselling and prophylactic treatment with HCQ should be encouraged. [ABSTRACT FROM AUTHOR]
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- 2021
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35. Facial rash in a newborn
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Sílvia Mota, Carla Sá, Nicole Silva, Filipa Almeida, Ana Paula Vieira, and Almerinda Pereira
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neonatal lupus ,neonatal autoimmune disease ,sjögren syndrome type a antigen antibodies ,congenital heart block ,facial rash ,skin lesions ,Medicine ,Pediatrics ,RJ1-570 - Abstract
A female newborn, born at 38 weeks from an uncomplicated pregnancy in a healthy 36-years-old mother, presented at birth with desquamative erythematous plaques with irregular borders, distributed bilaterally in the orbital, nasal and malar regions. Although there was no history of maternal autoimmune disease, neonatal lupus (NL) was suspected. Maternal and newborn screenings were positive for Sjögren syndrome type A antigen (anti-Ro/SSA) antibodies. No other alterations of NL were found in the newborn. Rheumatologic consultation on the mother showed no other alterations besides the antibodies. The newborn was discharged on day 3 of life without treatment and recommendations to avoid sun exposure. Outpatient follow-up was ensured in neonatology, dermatology and pediatric cardiology. The rash resolved during the first year of life, leaving slight local skin atrophy. NL is a rare transferred autoimmune disease with an incidence estimated as 1:20,000 live births. It occurs due to placental transfer of maternal autoantibodies. The major manifestations are cardiac and cutaneous, but hepatic, hematologic or neurologic findings may also be present. The rash usually affects the face and scalp and may be present at delivery but more often develops later, after exposure to ultraviolet light. It usually resolves within the first year of life without sequelae. NL is the leading cause of congenital heart block, but if it is not present at birth it rarely develops. Some mothers do not have a known autoimmune disease at the time of birth but may develop it later in life. Despite NL being a passively acquired autoimmune disease, the child is at increased risk of rheumatologic disease in childhood or adolescence.
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- 2021
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36. Sjogren's Antibodies and Neonatal Lupus: A Scoping Review.
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Nagliya D, Castellano C, Demory ML, and Kesselman MM
- Abstract
Sjogren's syndrome (SS) is an autoimmune disease characterized by inflammation of exocrine glands. The disorder predominantly affects middle-aged women. Autoantibodies, including anti-SS-A/Ro and anti-SS-B/La antibodies, are present in most cases of SS. These antibodies can cross the placenta and likely play a role in pregnancy complications as well as the development of neonatal lupus, resulting in congenital heart block (CHB). It is essential to monitor the fetus for CHB during pregnancy. In particular, screening with echocardiography and monitoring heart rate at home are recommended practices. Regarding medical management, hydroxychloroquine and glucocorticoids have shown promise in reducing cardiac manifestations, but further research is needed to elucidate their longer term efficacy and safety. This scoping review analyzes literature from 2001 to 2024, focusing on pregnancy outcomes among women with SS, clinical manifestations of neonatal lupus, the role of anti-SS-A/Ro and anti-SS-B/La antibodies in the development of neonatal lupus and CHB, and emphasizes the need for future research efforts to refine treatment protocols and enhance clinical care strategies for pregnant women with SS., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Nagliya et al.)
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- 2024
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37. Ethnicity and Neonatal Lupus Erythematosus Manifestations Risk in a Large Multiethnic Cohort.
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Diaz, Talia, Dominguez, Daniela, Jaeggi, Edgar, Knight, Andrea M., Laskin, Carl A., Ng, Lawrence, Silverio, Franklin, Silverman, Earl D., and Hiraki, Linda T.
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LUPUS erythematosus treatment ,LUPUS erythematosus complications ,NEONATAL diseases ,SICK children ,ETHNICITY - Abstract
Objective: To evaluate the association between ethnicity and neonatal lupus erythematosus (NLE), as well as specific NLE manifestations in a large multiethnic population.Methods: We conducted a cohort study of the children (≤ 1 yr of age) seen in the NLE clinic at The Hospital for Sick Children (SickKids), between January 2011 and April 2019. The cohort was divided into European, non-European, and mixed European-non-European groups according to parent-reported child's ethnicity (Canada Census categories). Outcomes were NLE and specific NLE manifestations (cardiac, cutaneous, cytopenias, transaminitis, and macrocephaly). The frequency of NLE and specific manifestations were compared between ethnic groups (Fisher exact test). We tested the association between ethnicity and (1) NLE risk, and (2) specific NLE manifestations with logistic regression models, including covariates for child's sex, maternal rheumatic disease status during pregnancy, and maternal use of antimalarials during pregnancy (multiple comparisons threshold P < 0.008).Results: We included 324 children born to 270 anti-Ro antibody-positive mothers. Median age at first visit was 1.8 (IQR 1.4-2.3) months, and median follow-up time was 12 (IQR 2-24) months. The majority was non-European (48%), with 34% European, and 18% mixed European-non-European. There was no significant association between non-European ethnicity (OR 1.18, 95% CI 0.71-1.94, P = 0.51), mixed European-non-European ethnicity (OR 1.13, 95% CI 0.59-2.16, P = 0.70), and NLE risk compared with European ethnicity. We also did not find an association between ethnicity and specific NLE manifestations in univariate or multivariable-adjusted models.Conclusion: In a large multiethnic cohort, there was no association between a child's ethnicity and NLE risk or specific NLE manifestations. [ABSTRACT FROM AUTHOR]- Published
- 2021
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38. Simple Surgical Technique for Epicardial Pacemaker Wire Preparation and Insertion.
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Mishra, Amit, Patel, Kartik, Ananthanarayananh, Chandrasekaran, Wadhawa, Vivek, and Pandya, Himani
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- *
CARDIAC surgery , *ARRHYTHMIA , *DISEASE complications , *DEATH , *CARDIAC pacing - Abstract
Epicardial pacing wire (EPW) insertion is an integral part of open heart surgery. However, the use of EPW insertion is also associated with complications such as bleeding, tamponade, arrhythmias, and occasionally even death of the patient. Various techniques have been described for preparing, placing, and removing EPW. We present our simple, yet effective technique of preparing, inserting, and removing EPW where the incidence of complications is nil. [ABSTRACT FROM AUTHOR]
- Published
- 2022
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39. Late-Onset Dilated Cardiomyopathy in Auto Immune-Mediated Complete Congenital Heart Block: A Case Report.
- Author
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Dharmagadda A, Tambolkar S, Chavan S, and Garlapati S
- Abstract
Complete congenital heart block (CHB), a rare and fatal bradyarrhythmia observed in children, carries significant mortality and morbidity. When congenital heart block occurs in isolation with a structurally normal heart, it prompts suspicion of an autoimmune etiology, wherein maternal antibodies are transmitted transplacentally, impacting the fetal conducting system. The manifestation of congenital complete atrioventricular block (CCAVB) can lead to complications such as dilated cardiomyopathies, arrhythmias, and fibroelastosis in certain cases. Notably, dilated cardiomyopathy is a significant prognostic factor in children diagnosed with congenital heart block. Pathological investigations have revealed the presence of antibodies, complements, and indicators of inflammation or fibrosis across the myocardium, emphasizing the shared molecular mechanisms between CCAVB and the development of dilated cardiomyopathy (DCM). This article presents the case of a one-year-old female child who presented with signs of dilated cardiomyopathy, later identified through retrospective evaluation as having autoimmune congenital heart block. The mother of the child was diagnosed with Sjogren's syndrome, characterized by positive anti-RO titers. Remarkably, the child remained asymptomatic for a year without the need for pacing intervention. The child's condition was successfully stabilized with appropriate treatment, and plans for pacemaker insertion will be considered once specific criteria are met. The onset of cardiomyopathy in a known case of CCAVB should serve as a crucial alert for prognostic considerations and the potential necessity for early-pacing intervention., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Dharmagadda et al.)
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- 2024
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40. Studies in the Area of Congenital Heart Block Reported from Brigham and Women's Hospital (Expert Perspective On a Clinical Challenge: Lupus and Pregnancy).
- Abstract
A recent report from Brigham and Women's Hospital in Boston, Massachusetts discusses the challenges of managing systemic lupus erythematosus (SLE) during pregnancy. The researchers emphasize the importance of achieving remission or low disease activity before conception to reduce the risk of complications such as pre-eclampsia and preterm birth. They recommend that expectant mothers with a history of antiphospholipid syndrome receive anticoagulant therapy, and that women with certain antibodies undergo additional monitoring due to the increased risk of congenital heart block in their offspring. The researchers also discuss the use of medications during pregnancy and the difficulty of distinguishing between a flare of lupus nephritis and pre-eclampsia. Overall, while outcomes for pregnant women with lupus are improving, there are still gaps in knowledge regarding optimal management strategies. [Extracted from the article]
- Published
- 2024
41. Pregnancy and Inflammatory Rheumatological Diseases: A Single-Center Retrospective Cohort Study.
- Author
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Alkhodier AA, Alsaif AS, Alqntash NH, Alanazi RB, Alotaibi G, and Alrashid A
- Abstract
Background Rheumatic diseases pose risks to pregnant women, leading to complications like preterm birth, congenital heart block, and pregnancy loss. These diseases are expected to deteriorate during pregnancy and further in the postpartum period. The impact of these diseases on the pregnancy will add further burden on the patient, fetus, physician, and healthcare system. Advances in diagnosis and treatment have improved outcomes making them similar to that of healthy women, but close follow-up in a multidisciplinary clinic is essential. The objective of this study is to study the outcome of pregnancy in women with rheumatological disease and the behavior of the disease during pregnancy. Methods A retrospective cohort study was conducted in King Abdulaziz Medical City (KAMC) in Riyadh, Saudi Arabia, to compare the outcomes of pregnancy across three rheumatological diseases: Sjogren syndrome (SS), systemic lupus erythematosus (SLE), and rheumatoid arthritis (RA) from 2016 to 2021. A total of 128 pregnancies in 107 women with rheumatological diseases were included in this study. Pregnancy measures and outcomes were investigated by assessing maternal health, fetal health, and pregnancy complications, specifically maternal disease activity, medications to control the disease, infection, preterm birth, birth weight, abortions/stillbirths, mode of delivery, bleeding, preeclampsia, congenital heart block, and neonatal lupus. Results There were 55 patients with RA (63 RA pregnancies), 44 with SLE (54 SLE pregnancies), and eight with primary SS (11 SS pregnancies). In most of the pregnancies (n= 108; 95.58%), the patients were in clinical remission before pregnancy. Lupus nephritis, which was in remission before pregnancy, has been reported in nine (16.67%) out of 54 SLE pregnancies. Vaginal delivery was the most common mode of delivery (n=87; 67.97%). On the other hand, there were 38 cesarean sections (29.69%). Rheumatological disease flares occurred in 10 pregnancies (7.87%). One hundred and twenty-two live births were delivered. Preterm infants were born in 25 pregnancies (20.16%), and 16 (13.22%) of the newborns needed neonatal intensive care unit (NICU) care. Interestingly, congenital heart block (CHB) was found in five (12.2%) neonates out of 41 anti-SS-related antigen A (anti-SSA) positive mothers; one of those five died from heart block. Eleven neonates were delivered with positive serology, and five were diagnosed with neonatal lupus. Conclusion The outcome of pregnancy in patients with rheumatological disease is favorable. A multidisciplinary team approach and close clinical follow-up are the cornerstone for such success. A small dose of prednisolone (5 mg or less) is safe and will not have a negative impact on maternal or fetal health. CHB is a concern for pregnant women with positive anti-SSA., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Alkhodier et al.)
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- 2023
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42. Rare complications of Sjögren’s syndrome in a female patient
- Author
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Rosan, Tin, Jelenić, Jana, and Bakula, Marija
- Subjects
central nervous system ,congenital heart block ,Sjögren’s syndrome ,SSA-antibodies - Abstract
Sjögren’s syndrome (SjS) is a systemic autoimmune disease, most common in middle-aged women, characterized by chronic inflammation of exocrine glands. It can present by itself or alongside other autoimmune diseases. Main symptoms are dry eyes and mouth, but the disease can affect joints, lungs, kidneys, peripheral nervous system (PNS), and rarely central nervous system (CNS). SS-A antibodies in SjS can pass the fetoplacental barrier and cause congenital heart block. Patients with SjS are at higher risk of developing lymphoma.
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- 2023
43. New Findings from Clemson University Update Understanding of Congenital Heart Block (Identifying Congenital Heart Block In Primary Care).
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HEART block ,PRIMARY care ,CONGENITAL heart disease ,ARRHYTHMIA ,HEART abnormalities - Abstract
Keywords: Greenville; State:South Carolina; United States; North and Central America; Cardiac Arrhythmias; Cardiology; Congenital Diseases and Conditions; Congenital Heart Block; Health and Medicine; Heart Block; Heart Disease; Heart Disorders and Diseases EN Greenville State:South Carolina United States North and Central America Cardiac Arrhythmias Cardiology Congenital Diseases and Conditions Congenital Heart Block Health and Medicine Heart Block Heart Disease Heart Disorders and Diseases 459 459 1 10/24/23 20231023 NES 231023 2023 OCT 23 (NewsRx) -- By a News Reporter-Staff News Editor at Cardiovascular Week -- Investigators publish new report on Congenital Diseases and Conditions - Congenital Heart Block. Greenville, State:South Carolina, United States, North and Central America, Cardiac Arrhythmias, Cardiology, Congenital Diseases and Conditions, Congenital Heart Block, Health and Medicine, Heart Block, Heart Disease, Heart Disorders and Diseases. [Extracted from the article]
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- 2023
44. Cohort study of congenital complete heart block among preterm neonates: a single-center experience over a 15-year period
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Virginie Meau-Petit, William Regan, Eric Rosenthal, Hitarth Bhatt, and Hayley Hernstadt
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Pediatrics ,medicine.medical_specialty ,Neonatal intensive care unit ,Gestational Age ,Infant, Premature, Diseases ,Congenital heart block ,Antenatal steroid ,Cohort Studies ,Neonate ,Pregnancy ,Complete heart block ,Risk of mortality ,Humans ,Medicine ,business.industry ,Infant, Newborn ,Infant ,medicine.disease ,Heart Block ,Intraventricular hemorrhage ,Pediatrics, Perinatology and Child Health ,Necrotizing enterocolitis ,Cohort ,Gestation ,Original Article ,Female ,Prematurity ,business ,Infant, Premature ,Cohort study - Abstract
Congenital complete heart block (CCHB) is a very rare condition, with high risk of mortality. Prematurity is associated with immaturity of the cardiovascular system. Morbidity related to CCHB and prematurity has never been described. We describe a tertiary perinatal center experience over a 15-year period on CCHB management and complications in preterm infants. This is a single-center observational cohort study. All neonates admitted to neonatal intensive care unit with a diagnosis of isolated CCHB between January 2006 and January 2021 were identified. All preterm neonates (
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- 2021
45. Congenital Heart Block and Its Association With Anti-Ro and Anti-La Antibodies in Pregnancy: A Case Report of a Rare Entity and a Review of the Current Evidence.
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Sapantzoglou I, Fasoulakis Z, Daskalakis G, Theodora M, and Antsaklis P
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Systemic lupus erythematosus (SLE) is a heterogeneous chronic, multisystem, inflammatory autoimmune disorder with variable clinical features, with its manifestations being attributed to the presence of multiple autoantibodies and their subsequent autoimmune reactions. Multiple organs may be involved, with the kidneys, the joints, and the skin being the most common, increasing maternal and fetal morbidity and mortality. Our current article describes the case of a 32-year-old primigravida who was referred to our department after the detection of fetal bradycardia and the strong suspicion of an underlying cardiac abnormality. After a detailed fetal and maternal assessment, the diagnosis of SLE-associated fetal congenital heart block was established, and the appropriate management and treatment were provided, factors that led to the uncomplicated delivery and prompt successful management of an otherwise severely affected fetus. Our work, also, includes a detailed review of the accumulated evidence regarding the association between autoantibodies and congenital heart block, the available screening modalities of the condition, and its potential therapeutic interventions., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Sapantzoglou et al.)
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- 2023
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46. Congenital Heart Block.
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Steinberg L
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- Humans, Heart Block diagnosis, Heart Block therapy, Pacemaker, Artificial, Heart Defects, Congenital complications, Heart Defects, Congenital genetics, Heart Defects, Congenital therapy, Atrioventricular Block diagnosis, Atrioventricular Block therapy
- Abstract
Congenital complete heart block (CCHB) defines atrioventricular conduction abnormalities diagnosed in utero or within the first 27 days of life. Maternal autoimmune disease and congenital heart defects are most commonly responsible. Recent genetic discoveries have highlighted our understanding of the underlying mechanism. Hydroxychloroquine shows promise in preventing autoimmune CCHB. Patients may develop symptomatic bradycardia and cardiomyopathy. The presence of these and other specific findings warrants placement of a permanent pacemaker to relieve symptoms and prevent catastrophic events. The mechanisms, natural history, evaluation, and treatment of patients with or at risk for CCHB are reviewed., (Copyright © 2023 Elsevier Inc. All rights reserved.)
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- 2023
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47. New Congenital Heart Block Study Results from Cochin Hospital Described (Health Outcomes of 215 Mothers of Children With Autoimmune Congenital Heart Block: Analysis of the French Neonatal Lupus Syndrome Registry).
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HEART block ,SYSTEMIC lupus erythematosus ,CONGENITAL heart disease ,SYNDROMES ,CONGENITAL disorders - Abstract
Keywords: Paris; France; Europe; Autoimmune Diseases and Conditions; Autoimmunity; Cardiac Arrhythmias; Cardiology; Congenital Diseases and Conditions; Congenital Heart Block; Diagnostics and Screening; Health and Medicine; Heart Block; Heart Disease; Heart Disorders and Diseases; Immune System Diseases and Conditions; Immunology; Lupus; Systemic Lupus Erythematosus EN Paris France Europe Autoimmune Diseases and Conditions Autoimmunity Cardiac Arrhythmias Cardiology Congenital Diseases and Conditions Congenital Heart Block Diagnostics and Screening Health and Medicine Heart Block Heart Disease Heart Disorders and Diseases Immune System Diseases and Conditions Immunology Lupus Systemic Lupus Erythematosus 547 547 1 09/11/23 20230911 NES 230911 2023 SEP 11 (NewsRx) -- By a News Reporter-Staff News Editor at Cardiovascular Week -- New research on Congenital Diseases and Conditions - Congenital Heart Block is the subject of a report. Paris, France, Europe, Autoimmune Diseases and Conditions, Autoimmunity, Cardiac Arrhythmias, Cardiology, Congenital Diseases and Conditions, Congenital Heart Block, Diagnostics and Screening, Health and Medicine, Heart Block, Heart Disease, Heart Disorders and Diseases, Immune System Diseases and Conditions, Immunology, Lupus, Systemic Lupus Erythematosus. [Extracted from the article]
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- 2023
48. CR66 Rare complications of Sjögren’s syndrome in a female patient.
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Rosan, Tin, Jelenić, Jana, and Bakula, Marija
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SJOGREN'S syndrome ,PERIPHERAL nervous system ,HEART block ,WOMEN patients ,NERVOUS system ,MIDDLE-aged women - Abstract
INTRODUCTION/OBJECTIVES: Sjögren’s syndrome (SjS) is a systemic autoimmune disease, most common in middle-aged women, characterized by chronic inflammation of exocrine glands. It can present by itself or alongside other autoimmune diseases. Main symptoms are dry eyes and mouth, but the disease can affect joints, lungs, kidneys, peripheral nervous system (PNS), and rarely central nervous system (CNS). SS-A antibodies in SjS can pass the fetoplacental barrier and cause congenital heart block. Patients with SjS are at higher risk of developing lymphoma. CASE PRESENTATION: We present a case of a 40-year-old woman who was diagnosed with SjS in 2009, presenting with dry eyes and mouth, arthritis, alongside vasculitis i.e. purpura of the shins. She was treated with prednisone and chloroquine. In 2008 she gave birth to a child with complete atrioventricular block. Recently she complained of foot numbness without motor weakness. Now she was hospitalized due to symptoms of meningoencephalitis. Cerebrospinal fluid (CSF) analysis was positive for oligoclonal bands. CSF, urine, and blood cultures were sterile. MRI showed pathomorphological findings in cauda equina. Neuropathy of thin sensory and motor fibers was found on electromyoneurography. The patient was treated with antibiotics, methylprednisolone, intravenous immunoglobulins, and supportive measures. She recovered completely and azathioprine was introduced for maintaining remission. CONCLUSION: Overall nervous system manifestations are described in 20% of patients with primary SjS, but CNS manifestations are described rarely. Congenital heart block is described in 2% of the pregnancies in mothers with SS-A antibodies. With timely introduction of immunosuppressants the conditions are treatable and preventable. [ABSTRACT FROM AUTHOR]
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- 2023
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49. Autoimmune Congenital Complete Heart Block: How Late Can It Occur?
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Makadia L, Izmirly P, Buyon JP, and Phoon CKL
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Objective Maternal anti-Ro (SSA) and/or anti-La (SSB) antibodies are a risk factor for congenital complete heart block (CHB). Because detailed analysis of the incidence of CHB after 24 weeks of gestational age (GA) is lacking, we aimed to ascertain the risk of "later-onset" CHB among offspring of SSA/SSB-positive mothers in the published literature. Study Design Using search terms "neonatal lupus heart block" and "autoimmune congenital heart block" on PubMed and Ovid, we gathered prospective studies of SSA/SSB-positive mothers with fetal echo surveillance starting from before CHB diagnosis and retrospective cases of fetal CHB diagnosis after 24 weeks of GA (if there was prior normal heart rate) or after birth. Results Ten prospective studies included 1,248 SSA/SSB-positive pregnancies with 24 cases of CHB diagnosed during pregnancy (1.9%). Among these, three (12.5%) were after 24 weeks-at weeks 25, 26, and 28. Our retrospective studies revealed 50 patients with CHB diagnosis in late fetal life and neonatal period and 34 in the nonneonatal childhood period. An additional four cases were diagnosed after age 18 years. Conclusion Later-onset autoimmune CHB in offspring of SSA/SSB-positive mothers does occur. Our analysis suggests that prenatal surveillance should continue beyond 24 weeks of GA but is limited by inconsistent published surveillance data., Competing Interests: Conflict of Interest None declared., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ).)
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- 2023
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50. Case report: Challenges and implications of conduction system pacing in pediatrics: Case series.
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Ploneda Valencia RG, Levinstein Jacinto M, Sánchez Contreras CA, Ruiz González G, Neach de la Vega D, Márquez Murillo MF, and Nava S
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Cardiac electrical stimulation in children usually is needed in the setting of complete congenital atrioventricular block, atrioventricular block after heart surgery, and bradycardia associated with some specific channelopathies. In cases of atrioventricular block, the high percentage of ventricular stimulation raises concern on the deleterious effects of chronic stimulation of the right ventricle. In recent years, physiologic stimulation has developed as a valid approach for adult patients and a great interest has risen in offering conduction system pacing also to the pediatric population. We present three pediatric cases of stimulation of the conduction system (His bundle or left bundle branch), in order to show the intrinsic particularities and challenges implied in these new techniques., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Ploneda Valencia, Levinstein Jacinto, Sánchez Contreras, Ruiz González, Neach de la Vega, Marquez, MD, FACC and Nava.)
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- 2023
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