A new therapeutic approach to the fetus with congenital complete heart block: preemptive, targeted therapy with dexamethasone.
BACKGROUND
Therapy of established congenital complete heart block in the fetus has resulted in improved survival but persistence of heart block. This exposes the infant to the morbidity of heart block, including the risk of sudden death and pacemaker implantation.


METHODS
A 35-year-old gravida 2, para 1, with Sjogren syndrome and a previous pregnancy complicated by congenital complete heart block presented during her second pregnancy. Intensive fetal monitoring with echocardiography was employed. Early evidence of myocardial dysfunction and dysrhythmia was found, dexamethasone therapy was initiated, and the dysfunction and dysrhythmia resolved. The pregnancy went to term without further complication.


CONCLUSIONS
This represents a new and successful strategy to identify very early signs of myocardial disease in a fetus at high risk of congenital complete heart block, enabling targeted, preemptive therapy.
Department of Pediatric Cardiology, Stanford University Medical School, California 94304, USA.
D
D
Rosenthal
M
M
Druzin
C
C
Chin
A
A
Dubin
D000328:Adult; D003907:Dexamethasone / Q000627:therapeutic use*; D005260:Female; D005315:Fetal Diseases / Q000517:prevention & control*; D006327:Heart Block / Q000151:congenital* / Q000517:prevention & control*; D006801:Humans; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular
D003907:Dexamethasone