23 Congenital Complete Heart Block
A 35-year-old white woman, gravida 4, para 2, was referred at 22 weeks’ gestation by the obstetrician for fetal bradycardia. The mother has systemic lupus erythematosus (SLE) with a high titer of anti-Ro (SSA) antibodies. Her cardiac evaluation showed unifocal premature ventricular contractions (PVCs) but no evidence of myocardial dysfunction or pericarditis.
8. There is no evidence of valvar regurgitation (AV or semilunar). However, there is occasional intermittent tricuspid valve regurgitation related to the AV sequence. There is also a very low velocity diastolic regurgitation, which is normal in complete heart block (CHB).
2. Many asymptomatic patients reach adult life without pacing, but the risk of sudden death is 5% during adult life. For this reason, dual-chamber pacemaker implantation is increasingly advocated routinely in adolescence.