title: A combination therapy to treat second-degree anti-Ro/La-related congenital heart block: a strategy to avoid stable third-degree heart block?
abstract: While mainly based on the use of fluorinated steroids, there is no standard management of anti-Ro/La-related congenital heart block (CHB). This is a report concerning two consecutive cases of anti-Ro/La-related second-degree block treated with betamethasone (4 mg/day), weekly plasmapheresis, and intravenous immunoglobulins (IVIGs; 1 g/kg) administered every 15 days, a therapy that was begun shortly after CHB was detected and continued until delivery. The newborns were also treated with IVIG (1 g/kg) soon after birth and continued fortnightly until the anti-Ro/La antibody levels became undetectable. In both cases second-degree AV block reverted to a stable sinus rhythm with a first-degree atrioventricular (AV) block. Moreover, there was no recurrence of CHB when therapy was suspended, as confirmed by a 29 month and an eight month follow-up, respectively.
authors.affiliation: Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Padua, Padua, Italy. amelia.ruffatti@unipd.it
authors.forename: A
authors.initials: A
authors.lastname: Ruffatti
authors.forename: O
authors.initials: O
authors.lastname: Milanesi
authors.forename: L
authors.initials: L
authors.lastname: Chiandetti
authors.forename: A
authors.initials: A
authors.lastname: Cerutti
authors.forename: M T
authors.initials: MT
authors.lastname: Gervasi
authors.forename: G
authors.initials: G
authors.lastname: De Silvestro
authors.forename: V
authors.initials: V
authors.lastname: Pengo
authors.forename: L
authors.initials: L
authors.lastname: Punzi
mesh_terms: D000328:Adult; D000974:Antibodies, Antinuclear / Q000097:blood*; D001623:Betamethasone / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D005260:Female; D006327:Heart Block / Q000097:blood / Q000151:congenital* / Q000276:immunology / Q000628:therapy; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007231:Infant, Newborn; D010956:Plasmapheresis; D011247:Pregnancy; D012008:Recurrence; D016896:Treatment Outcome
chemical_list: D000974:Antibodies, Antinuclear; D016756:Immunoglobulins, Intravenous; C035356:SS-A antibodies; C035357:SS-B antibodies; D001623:Betamethasone