Congenital fetal heart block: a potential therapeutic role for intravenous immunoglobulin.
BACKGROUND
Congenital heart block affects 2% of all mothers with anti-Ro/La antibodies, can cause heart failure in utero, and has a 20% mortality rate in the first 3 years of life. Maternal fluorinated steroids to prevent or reverse congenital heart block can cause pregnancy complications. Intravenous immunoglobulin (IVIG) has been given with maternal steroids to prevent the recurrence of congenital heart block, although its efficacy is unproven.


METHODS
We report the use of IVIG to prevent progression of 2:1 congenital heart block with intermittent complete heart block. After two maternal infusions of IVIG (0.4 g/kg) at 31 weeks of gestation, the fetal heart rate reverted to long periods of sinus rhythm, which was sustained until postnatal life.


CONCLUSIONS
Our case supports investigating IVIG in the prevention or treatment of this life-threatening condition.
David
Anna L
AL
From the Institute for Women's Health, University College London Hospitals; the Cardiac Unit, Great Ormond Street Hospital for Children NHS Trust; and the Division of Immunology, Hammersmith Hospitals NHS Trust, London, United Kingdom.
Ataullah
Ifat
I
Yates
Rob
R
Sullivan
Ian
I
Charles
Peter
P
Williams
David
D
D000328:Adult; D000974:Antibodies, Antinuclear / Q000276:immunology; D001324:Autoantigens / Q000276:immunology; D005260:Female; D005315:Fetal Diseases / Q000188:drug therapy* / Q000276:immunology; D006327:Heart Block / Q000151:congenital / Q000188:drug therapy* / Q000276:immunology; D006330:Heart Defects, Congenital; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007231:Infant, Newborn; D011247:Pregnancy; D011248:Pregnancy Complications / Q000276:immunology*; D011256:Pregnancy Outcome; D012261:Ribonucleoproteins / Q000276:immunology; D012859:Sjogren's Syndrome / Q000150:complications / Q000276:immunology*; D000097585:SS-B Antigen
D000974:Antibodies, Antinuclear; D001324:Autoantigens; D016756:Immunoglobulins, Intravenous; D012261:Ribonucleoproteins; D000097585:SS-B Antigen; C035356:SS-A antibodies