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J Thorac Cardiovasc Surg 2003;126:300-302
© 2003 The American Association for Thoracic Surgery

Brief communication

New lead for in utero pacing for fetal congenital heart block

^a Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
^b Institute of Cardiology, Porto Alegre, Brazil

Presented at the 4th World Congress of Pediatric Cardiology and Cardiac Surgery, Toronto, Canada, May 2001.

Received for publication September 9, 2002; accepted for publication October 23, 2002.

^* Address for reprints: Renato S. Assad, MD, Heart Institute, University of São Paulo, Division of Surgery, Av Dr Eneas Carvalho Aguiar, 44, São Paulo, SP 05403-000 Brazil
rsassad@cardiol.br

The first 300 words of the full text of this article appear below.

Marcial, Assad, Oliveira, Costa (left to right)

Kalil, Lima, Zielinsky, Santos, Aramayo (left to right)

Complete heart block occurs in 4% to 15% of cases of fetal arrhythmia. Although it is usually well tolerated in the absence of complicating cardiac anomalies, as many as 25% of these fetuses have hydrops and die in utero.¹ The pathophysiologic arguments for fetal ventricular pacing are compelling. We describe the case of a fetus presenting with complete heart block, hydrops, and associated structural heart defects, the mother of whom consented to attempts at in utero pacing. The purpose of this article is to describe a new lead for percutaneous implantation that minimizes surgical trauma to both the fetus and the mother.

Clinical summary

A 36-year-old woman was referred to the Institute of Cardiology Porto Alegre at 18 weeks’ gestation with a fetus presenting with complete heart block (heart rate, 47 beats/min), marked hydrops, left atrial isomerism, and an atrioventricular septal defect. Maternal therapy with positive chronotropic drugs and steroids did not reverse the low output failure and low fetal heart rate. A follow-up maternal ultrasound examination at 24 weeks’ gestation suggested decreased right ventricular contractility in the fetus and abdominal and pleural effusions.

With the risk of fetal demise approaching 100%, fetal pacing was considered. After extensive discussions with the physicians involved with the Fetal Cardiology Research Program of the Heart Institute University of São Paulo and the Institute of Cardiology Porto Alegre, including explanation of the procedure’s benefits and risks, the patient consented to attempts at in utero transthoracic fetal ventricular pacing. The procedure was performed at 25 weeks’ gestation according to a protocol approved by our institutional ethics committee on human research.

Anesthesia
The mother was sedated with intravenous midazolam and fentanyl citrate. Xylocaine 1% was infiltrated subcutaneously in her abdomen in preparation . . . [Full Text of this Article]

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