P123Congenital complete heart block. Prenatal diagnosis and successful fetal therapy

Objective Congenital complete heart block (CCHB) affects 1:20.000 live births. This condition reappears in 18–24% of future pregnancys. 50% of the fetuses have a structural cardiac anomalies. It may present isolated or in mothers with autoinmune disease, or positive anti-Ro (SSA) and anti-La (SSB) antibodies. Our purpose is to show the improvement in perinatal outcome using 2D echocardiografy and foetal Doppler to diagnose CCHB in the prenatal period. Case report We present a 36-year-old female patient with 2 previous stillborns due to CCHB. She was positive for anti SSA and anti SSB antibodies and was evaluated for the first time at 22 weeks of her third pregnancy. An Echography showed foetal hydrops, and echocardiography showed an anatomically normal heart, with a complete heart block. The atrial rate was 120/min. and the ventricular rate was 60/min. Treatment was started with dexametasone 4 mg/day, salbutamol 12 mg/day and Sandoglubulin (Novartis) 400 mg/kg. Following sonographys showed resolution of fetal hydrops, improvement in cardiac function and cardiac rates. Cesarian section at 34 weeks, newborn 2420 g. At day 7 a permanent pacemaker was implanted. Conclusions Fetal echocardiography is the best method to diagnose and treat CCHB in the prenatal period. The use of glucocorticoids, betamimetics and immunoglobulins has shown to be of benefit.