11/47. Twin brothers with MIDAS syndrome and XX karyotype.Twin brothers with microphthalmia, facial dermal hypoplasia, sclerocornea, and supraventricular tachycardia, are reported. Their clinical features are compatible with MIDAS syndrome, a known X-linked and hemizygous male lethal condition. Their karyotypes showed an XX sex chromosome modality with a subtle Xp/Yp translocation proven by the presence of SRY gene. The pregnancy was complicated with fetal supraventricular tachycardia, which was treated with digoxin prenatally. Postnatally, both twins required treatment with adenosine, digoxin, and propanolol to remain in normal sinus rhythm. The possible involvement of the heart, only in the form of cardiomyopathy with arrhythmia is emphasized. Both twins had a selective X-inactivation of the derivative chromosome X with Xp/Yp translocation.- - - - - - - - - - ranking = 1keywords = pregnancy (Clic here for more details about this article) |
12/47. Persistent junctional reciprocating tachycardia in the fetus.BACKGROUND: Persistent junctional reciprocating tachycardia (PJRT) tends to be a persistent arrhythmia and requires aggressive therapeutic management. diagnosis and management of this infrequently occurring tachycardia in the fetus at an early stage is of importance for the prevention of congestive heart failure (CHF). methods: A retrospective study of four fetuses with supraventricular tachycardia (SVT) of the PJRT type was performed. RESULTS: All had sustained SVT (mean of 228 beats/min) at a mean gestational age of 34 5 weeks, with CHF present in two. Three fetuses had prenatal characteristics of PJRT on M-mode echocardiography with a ventriculoatrial (VA)/atrioventricular ratio of > 1 on M-mode echocardiography suggesting a slow conducting accessory pathway. All four fetuses had postnatal confirmation of the diagnosis. Transplacental treatment with flecainide was effective in one patient; sotalol as a single drug or in combination with digoxin was partially effective in the remaining three. Two developed sinus rhythm, with short intermittent periods of tachycardia and decreasing signs of CHF; one case showed a minimal decrease in heart rate. Oral propranolol therapy converted two patients postnatally; in the remaining two patients radiofrequency ablation was performed at the age of 5 months and 6 years. CONCLUSIONS: The characteristics of our prenatal PJRT cases included a sustained heart rate not exceeding 240 beats/min with a long VA interval, the presence of CHF and therapy resistance. Transplacental treatment should be initiated, possibly with a combination of sotalol and digoxin in non-hydropic cases, or flecainide, especially in case of fetal hydrops. Pharmacological therapy is to be preferred postnatally, but radiofrequency ablation seems to be indicated in therapy-resistant cases with CHF, even in the first months of life.- - - - - - - - - - ranking = 4.7195429184048keywords = gestation (Clic here for more details about this article) |
13/47. Ebstein's anomaly presenting as Wolff-Parkinson white syndrome in a postpartum patient.Ebstein's anomaly is a common congenital abnormality in the Wolff-Parkinson white syndrome (WPW). The term WPW is applied to patients with both preexcitation on ECG and paroxysmal tachycardias. In this case review, we describe a female with a history of intermittent palpitations who presented in the postpartum period with WPW. Subsequent testing revealed an underlying Ebstein's anomaly. In the united states, heart disease is responsible for 10% of maternal deaths. Although pregnancy is well known to exacerbate symptoms in patients with WPW, postpartum exacerbation has not been clearly described. This unusual case suggests that monitoring beyond the peurperium would be advisable in patients at risk to develop malignant tachyarrhythmias.- - - - - - - - - - ranking = 1keywords = pregnancy (Clic here for more details about this article) |
14/47. adenosine use in pregnancy: lack of effect on fetal heart rate.The treatment for supraventricular tachycardia in pregnancy is somewhat controversial. Although a variety of medications have been used to terminate this rhythm during pregnancy, all have actual or theoretical drawbacks. adenosine is a relatively new medication with an extremely short half-life and is effective in the treatment of supraventricular tachycardia. We report a case in which this medication was used successfully during pregnancy. In addition, we found that adenosine had no effect on fetal heart rate in this case.- - - - - - - - - - ranking = 7keywords = pregnancy (Clic here for more details about this article) |
15/47. Supraventricular tachycardia resistant to treatment in a pregnant woman.Supraventricular tachycardia is relatively common in pregnancy, and is related to the normal physiologic changes of the cardiovascular system in the gravid state. When the arrhythmia is secondary to an ectopic atrial focus of automaticity, it can be particularly difficult to convert to a normal sinus rhythm with medications or DC cardioversion. A case of supraventricular tachycardia complicating a normal pregnancy and resistant to treatment is presented, with particular attention devoted to flecainide and propranolol, agents ultimately effective in this patient.- - - - - - - - - - ranking = 2keywords = pregnancy (Clic here for more details about this article) |
16/47. Fetal atrial tachycardia diagnosed by magnetocardiography and direct fetal electrocardiography. A case report of treatment with propranolol hydrochloride.At 26 weeks of gestation, fetal tachyarrhythmias (about 250 bpm) and ascites were detected by ultrasonography, and oral treatment with propranolol (30 mg/day) was commenced. Within 10 h, the fetal heart rate changed to approximately 85 bpm. The averaged fetal magnetocardiogram triggered by R peaks showed P wave and QRS complexes and an extra P wave. In addition, many extra nonconducted P-waves were detected in a fetal direct electrocardiogram. At 27 weeks of gestation, fetal tachycardia occurred again, and arrhythmia was diagnosed as the result of a blocked premature atrial contraction (PAC) with intermittent atrial tachycardia by fetal electrocardiogram. Administration of transplacental propranolol (90 mg/day) resolved the fetal tachyarrhythmias and ascites. Further studies are required to evaluate the efficacy and adverse effects of propranolol for fetal atrial tachycardia.- - - - - - - - - - ranking = 9.4390858368095keywords = gestation (Clic here for more details about this article) |
17/47. Radiofrequency catheter ablation in drug refractory maternal supraventricular tachycardias in advanced pregnancy.BACKGROUND: Treatment of maternal tachyarrhythmias in pregnancy is a major clinical issue. Pharmacological treatment raises important concerns regarding partial efficacy and side effects. Radiofrequency ablation of arrhythmogenic substrate has rarely been performed during pregnancy because of the fetal risks related to x-ray exposure and potential fetomaternal procedural complications. CASES: Three women affected by supraventricular tachycardias refractory to pharmacological therapy underwent successful radiofrequency catheter ablation at 29 to 30 weeks' pregnancy. All patients had cesarean delivery of newborns with normal Apgar scores. CONCLUSION: Radiofrequency catheter ablation is an effective treatment of drug refractory maternal supraventricular tachycardias in advanced pregnancy. Further studies are required to establish its long-term fetal safety.- - - - - - - - - - ranking = 8keywords = pregnancy (Clic here for more details about this article) |
18/47. Supraventricular tachycardia in pregnancy.We present four cases of supraventricular tachycardia in pregnancy of varied aetiology. risk factors for the development of supraventricular tachycardia and options for obstetric anaesthetic management, during pregnancy, labour, and at Caesarean section are discussed. We recommend the use of adenosine as first line therapy.- - - - - - - - - - ranking = 6keywords = pregnancy (Clic here for more details about this article) |
19/47. Simultaneous supraventricular tachycardias in both fetuses of a twin gestation.BACKGROUND: Fetal supraventricular tachycardia confers an increased risk of cardiac failure, hydrops, and eventual intrauterine death. Although protocols for prenatal anti-arrhythmic treatment are now well established, few published reports discuss this condition in the setting of multiple pregnancies. CASE REPORT: A 20-year-old primigravida woman with a twin pregnancy presented at 31 weeks of gestation for routine obstetrical check-up which revealed simultaneous supraventricular tachycardia in both fetuses. She was treated with oral digoxin, resulting in successful cardioversion in both of the fetuses, which was maintained until they were delivered by caesarian section at 38 weeks gestation. However, several hours after birth, tachyarrhythmias recurred in each of the infants. Combined disopyramide therapy with digoxin was necessary to control their heart rates. CONCLUSION: The treatment of arrhythmia in fetuses of a multiple gestation presents unique issues, particularly when diagnosed prior to fetal lung maturity.- - - - - - - - - - ranking = 34.036800428833keywords = gestation, pregnancy (Clic here for more details about this article) |
20/47. Fetal/neonatal supraventricular tachycardia.At 38 weeks of gestation, a woman with a previously unremarkable pregnancy was noted to have fetal tachycardia without obvious cause. Fetal echocardiography resulted in a presumptive diagnosis of fetal atrial flutter with a 2:1 block. The newborn resumed the same rhythm. The neonate underwent transesophageal incremental overdrive pacing. A normal sinus rhythm was restored. The infant had no recurrence to age 6 months.- - - - - - - - - - ranking = 5.7195429184048keywords = gestation, pregnancy (Clic here for more details about this article) |
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