Krishnan A, Arya B, Moak JP, Donofrio MT. Outcomes of fetal echocardiographic surveillance in anti-SSA exposed fetuses at a large fetal cardiology center.
Prenat Diagn 2014;
34:1207-12. [PMID:
24989941 DOI:
10.1002/pd.4454]
[Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 05/15/2014] [Accepted: 06/28/2014] [Indexed: 11/11/2022]
Abstract
BACKGROUND
Echocardiography screening in anti-SSA antibody exposed fetuses is controversial.
OBJECTIVE
The aim of this study is to evaluate utility of fetal echocardiography in anti-SSA exposure.
METHODS
Echocardiograms performed over 9 years for maternal anti-SSA exposure were reviewed for atrioventricular (AV) block, cardiomyopathy, arrhythmias, effusion, valve abnormalities, or other abnormalities identified by the echocardiographer. Fetuses with AV block referred to our institution and subsequently found to be anti-SSA exposed were also identified.
RESULTS
Six hundred thirty six echocardiograms were performed on 140 fetuses (Cohort 1) of 134 women screened for maternal anti-SSA +/- anti-SSB antibodies. No fetuses developed second or third-degree AV block or cardiomyopathy (odds ratio 0.1, CI 0.0051 to 1.9410, p = 0.13). Dexamethasone was administered to three fetuses for sinus bradycardia, echogenicity near AV node, and ventricular systolic dysfunction with valve regurgitation; all normalized. Screening echocardiograms identified: sinus bradycardia (n = 1), PR prolongation (n = 5), premature atrial contractions (n = 3), valve regurgitation (n = 24), echogenic myocardium (n = 4), and pericardial effusion (n = 1). Isolated tricuspid regurgitation and first-degree AV block did not progress. Nine cases of SSA-mediated AV block (Cohort 2) were referred after heart block developed.
CONCLUSIONS
Serial fetal echocardiography in anti-SSA exposed fetuses did not detect AV block. In rare cases, dexamethasone treatment may have affected disease course.
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