Prenatal diagnosis and treatment of fetal long QT syndrome: a case report.
We report a case of a fetus presenting with bradycardia, intermittent atrioventricular (AV) block, ventricular tachycardia (VT) and the signs of fetal congestive heart failure (ascites and scrotal hydrocele) during mid-gestation. Prenatal treatment with beta-adrenergic blocker (propranolol) and digitalis glycosides was prescribed because of suspicion of long QT syndrome occurring with fetal congestive heart failure. The male baby was born at 39 weeks of gestation and showed a prolonged QT interval (QTc = 492 ms) and frequent variable AV block or alternating left and right bundle branch block, depending on the atrial rate. Prenatal administration of lidocaine failed to correct the fetal VT. Conversely, propranolol decreased the attack frequency of fetal VT. Postnatal administration of the K(+) channel opener (nicorandil) successfully shortened the QT interval and improved the outcome.
Chang
Ing-Kuang
IK
Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan, Republic of China.
Shyu
Ming-Kwang
MK
Lee
Chien-Nan
CN
Kau
Miau-Ling
ML
Ko
Yu-Hsueh
YH
Chow
Song-Nan
SN
Hsieh
Fon-Jou
FJ
D000328:Adult; D001919:Bradycardia / Q000188:drug therapy / Q000532:radiotherapy; D002037:Bundle-Branch Block / Q000188:drug therapy / Q000209:etiology; D004562:Electrocardiography; D005260:Female; D005315:Fetal Diseases / Q000000981:diagnostic imaging* / Q000188:drug therapy; D006327:Heart Block / Q000188:drug therapy / Q000209:etiology; D006333:Heart Failure / Q000151:congenital / Q000188:drug therapy / Q000209:etiology; D006801:Humans; D007231:Infant, Newborn; D008012:Lidocaine / Q000627:therapeutic use; D008133:Long QT Syndrome / Q000150:complications / Q000151:congenital / Q000000981:diagnostic imaging / Q000188:drug therapy; D008297:Male; D020108:Nicorandil / Q000627:therapeutic use; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D011433:Propranolol / Q000627:therapeutic use; D017180:Tachycardia, Ventricular / Q000188:drug therapy / Q000209:etiology; D016216:Ultrasonography, Prenatal; D014665:Vasodilator Agents / Q000627:therapeutic use
D014665:Vasodilator Agents; D020108:Nicorandil; D008012:Lidocaine; D011433:Propranolol