Zusammenfassung
Hintergrund: Evaluation des klinischen Verlaufes von Feten mit vermuteten oder bewiesenen Bradykardien
auf dem Boden fetaler struktureller Herzfehler oder maternaler Kollagenose mit und
ohne Therapie. Methode: Retrospektive Auswertung von fetalen Echokardiographien bei 14 Schwangerschaften
(medianes Gestationsalter 25.5, Bereich 19 - 36 Schwangerschaftswochen). Die Indikation
zur Untersuchung bestand in einer mütterlichen Kollagenose oder in einer fetalen Bradyarrhythmie
mit oder ohne Verdacht auf Herzfehler. Der Nachweis mütterlicher Antikörper gegen
Ribonukleinsäure (Anti-Ro/SS-A, Anti-La/SS-B) erfolgte mit ELISA. Ergebnisse: Die 14 untersuchten Feten wiesen eine Bradyarrhythmie oder einen AV-Block auf, bei
7 in Verbindung mit einem Herzfehler, bei 7 ohne strukturelle kardiale Anomalie mit
Nachweis von maternalen Ro/La-Antikörpern. 6/7 Feten mit Vitium und 2/7 mit maternalen
Autoantikörpern verstarben perinatal. Eine maternale Steroidtherapie hatte keinen
Einfluss auf die Rhythmusstörung. Schlussfolgerung: Die fetale Echokardiographie bietet eine sichere Möglichkeit, Bradyarrhythmien und
atrioventrikuläre Blocks zu erkennen. Assoziiert mit einem Herzfehler ist die fetale
Prognose in unserem Kollektiv deutlich schlechter als in Kombination mit maternaler
Kollagenose.
Abstract
Background: The purpose of this study was to evaluate the clinical outcome of fetuses with bradyarrhythmias
or complete heart block (CHB) in the setting of fetal structural heart disease (CHD)
or of maternal collagenosis with and without treatment. Methods: A retrospective analysis of echocardiographic studies performed in 14 fetuses (mean
gestational age 25.5, range 19 - 36 weeks) referred for exclusion or diagnosis of
bradyarrhytmias was performed. Maternal SS-A/Ro and SS-B/La antibodies were measured
by ELISA. Results: 14 fetuses showed bradyarrhythmias or complete heart block in combination with severe
cardiac malformations (n = 7) or with positive maternal antibodies (n = 7). Only one
of the fetuses with CHD survived infancy as opposed to 5/7 fetuses with complete atrioventricular
block in the setting of maternal collagenosis. Maternal treatment with corticosteroids
did not seem to influence the rhythm disorder. Conclusion: Fetal echography is a safe method to detect bradyarrhythmias or complete atrioventricular
block. When associated with structural heart defects, fetal prognosis is poorer than
in combination with maternal collagenosis.
Schlüsselwörter
Kongenitaler atrioventrikulärer Block - fetale Doppler-Echokardiographie - Autoantikörper
Keywords
Congenital atrioventricular block - fetal doppler echocardiography - autoantibodies
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Dr. Martin Tollens
Kinderklinik und Poliklinik der Technischen Universität München
Kölner Platz 1
D-80804 München
Phone: 089-3068-2272
Fax: 089-3068-3954
Email: Tollens@lrz.tu-muenchen.de
