Fetal Congenital Heart Block

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read the abstract:  Prospective Cardiac Monitoring in Fetuses at Risk of Congenital Heart Block: The Pr Interval & Dexamethasone Evaluation (Pride) Study

Transcript

Alix Boyle: Hi, this is Alix Boyle reporting for OBGYN.net. Today, we are here with Dr. Joshua Copel from Yale University. Dr Copel, tell us about your research.

Josh Copel, MD: The project we are presenting here at the SMFM was a longitudinal study of women who were carrying fetuses at risk of developing various forms of congenital complete heart block and over several years, we were able to accumulate a pretty large population size of these fetuses at risk in order try and find out if there were markers we could use to identify those most likely to develop heart block and also try to get some insight into possible treatments.

Alix Boyle: In which population was the steroid therapy beneficial?

Josh Copel, MD: We only used steroids in fetuses that had evidence of heart block. We did not use steroids and would not advocate that right now for prevention of heart block, but in the fetuses that had evidence of what we consider first degree heart block, that is prolongation of the PR interval which can be measured mechanically in the fetus using Doppler technology, of the fetuses that had evidence of first degree heart block, we tried to treat two and both of them showed a reversion to normal patterns in the Doppler and both of those children were eventually born with normal cardiograms.

Alix Boyle: In which group was it the least beneficial?

Josh Copel, MD: There were three fetuses that had complete heart block; that is, total atrioventricular dissociation and none of those three showed any response to steroids. So at this point, we do not think that fetuses with established, complete heart block will respond to steroid therapy in terms of going back to a normal heart rate.

Alix Boyle: What is the next step in treating congenital heart block?

Josh Copel, MD: I think we still need to find the ideal marker. We had a couple fetuses who had complete heart block within a very short time, a week or two after having a normal ultrasound, so what we were looking at did not seem to be ideal in terms of being able to predict them and finding the right time for early intervention. So we are still looking for markers where we would like to have an inexpensive and safe means of prophylaxis.

Alix Boyle: That was Dr. Joshua Copel from Yale University. Thank you, Dr. Copel.