Spontaneous Remission of Congenital Complete Atrioventricular Block in Anti-Ro/La Antibody-Negative Monozygotic Twins: Case Report

Yıl 2017, Cilt: 34 Sayı: 1, 71 - 73, 01.01.2017

Taner Kasar Murat Saygı İsa Özyılmaz Yakup Ergül

Öz

Background: Congenital complete atrioventricular block without any structural heart disease and anti-Ro/La negativity is very rare. Discordant complete atrioventricular block, which is more frequently defined in the literature as an autoimmune mechanism, is much more rare in monozygotic twins. Case Report: The 26-year-old healthy mother had given birth in her first spontaneous, uneventful pregnancy to monozygotic twins at week 35. While the first twin’s physical examination proved her to be normal with a pulse rate consistent with her age, the second twin had a pulse rate of approximately 40 beats/minute.The patient was confirmed to have congenital complete atrioventricular block. Conclusion: Despite this case appears to be an isolated one, a discordant complete atrioventricular block regression without any autoimmune evidence should be included in the differential diagnosis of bradycardia in infants.

Anahtar Kelimeler

Anti-Ro/La antibody, congenital heart block, discordant complete atrioventricular block, infants

Kaynakça

• 1. Schmidt KG, Ulmer HE, Silverman NH, Kleinman CS, Copel JA. Perinatal outcome of fetal complete atrioventricular block: a multicenter experience. J Am Coll Cardiol 1991;17:1360-6.
• 2. Cooley HM, Keech CL, Melny BJ, Menahem S, Morahan G, Kay TW. Monozygotic twins discordant for congenital complete heart block. Arthritis Rheum 1997;40:381-4.
• 3. Mitra S, Saha AK, Sardar SK, Singh AK. Remission of congenital complete heart block without anti-Ro/La antibodies: A case report. Ann Pediatr Cardiol 2013;6:182-4.
• 4. Brucato A, Grava C, Bortolati M, Ikeda K, Milanesi O, Cimaz R, et al. Congenital heart block not associated with anti-Ro/La antibodies: Comparison with anti-Ro/La-positive cases. J Rheumatol 2009;36:1744-8.
• 5. Maeno Y, Himeno W, Saito A, Hiraishi S, Hirose O, Ikuma M, et al. Clinical course of fetal congenital atrioventricular block in the Japanese population: A multicentre experience. Heart 2005;91:1075-9.
• 6. Breur JM, Oudijk MA, Stoutenbeek P, Visser GH, Meijboom EJ. Transient non-autoimmune fetal heart block. Fetal Diagn Ther 2005;20:81-5.
• 7. Julkunen H, Miettinen A, Walle TK, Chan EK, Eronen M. Autoimmune response in mothers of children with congenital and postnatally diagnosed isolated heart block: A population based study. J Rheumatol 2004;31:183- 9.
• 8. Berg C, Geipel A, Kohl T, Breuer J, Germer U, Krapp M, et al. Atrioventricular block detected in fetal life: Associated anomalies and potential prognostic markers. Ultrasound Obstet Gynecol 2005;26:4-15.
• 9. Epstein AE, DiMarco JP, Ellenbogen KA, Estes NA 3rd, Freedman RA, Gettes LS, et al; American College of Cardiology Foundation; American Heart Association Task Force on Practice Guidelines; Heart Rhythm Society. 2012 ACCF/AHA/HRS focused update incorporated into the ACCF/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol 2013;61:e6-75.
• 10. Friedman DM, Rupel A, Buyon JP. Epidemiology, etiology, detection, and treatment of autoantibody-associated congenital heart block in neonatal lupus. Curr Rheumatol Rep 2007;9:101-8.