Spontaneous Remission Of Sick Sinus Syndrome In A Fetus With Pulmonary Stenosis Regurgitation
Kajiwara, K., Ishikawa, S., Mori, T., Samura, O., & Okamoto, A. (2019). Spontaneous Remission of Sick Sinus Syndrome in a Fetus with Pulmonary Stenosis Regurgitation. AJP reports, 9(4), e372–e375. https://doi.org/10.1055/s-0039-1695745
View Original Source →Abstract
Objective Here, we report a case of fetal sick sinus syndrome (SSS) caused by pulmonary stenosis regurgitation (PSR) that spontaneously resolved during pregnancy. Case Report A 29-year-old woman was referred to our hospital at 21 weeks of gestation for persistent fetal bradycardia. Fetal echocardiography revealed PSR and ventricular septal defect (VSD). The ventricular rate was 60 to 70 beats/minute with 1:1 atrioventricular conduction. Thus, congenital SSS owing to PSR was suspected. During pregnancy, fetal SSS spontaneously resolved at 28 weeks of gestation despite persistent PSR. The ventricular rate was increased to approximately 120 beats/minute with regular rhythm. A 2,390-g male neonate was delivered via Caesarean section at 38 weeks of gestation. Consequently, detailed echocardiography revealed PSR and VSD without SSS. Conclusion Although fetal PSR can cause fetal SSS owing to immaturity at an earlier gestational age, SSS might be spontaneously resolved by fetal heart development as pregnancy progresses.
Case Details
Disease Location
Heart
Personal Characteristics
29-year-old woman, gravida 1, para 0
Clinical Characteristics
Was referred to the hospital at 21 weeks of gestation because of persistent fetal bradycardia. Detailed ultrasonographic examination and ventricular septal defect diameter of vsd was 4 mm. The three-vessel view showed an enlarged main pulmonary artery. The right outflow tract showed pulmonary valve stenosis with regurgitation congenital sick sinus syndrome (sss) owing to pulmonary stenosis regurgitation (psr) was suspected. Postnatal diagnosis was consistent with the prenatal impression
Remission Characteristics
Fetal bradycardia spontaneously resolved at 28 weeks of gestation without any fetal treatment, regardless of persistent psr. Although the degree of psr did not change in the fetus, sss was absent throughout the pregnancy
Treatment & Mechanisms
Proposed Remission Mechanisms
Sss was resolved by maturation of the fetal heart as pregnancy progressed despite persistent psr