Spontaneous Remission of Sick Sinus Syndrome in a Fetus with Pulmonary Stenosis Regurgitation

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.

Keywords

pulmonary stenosis regurgitation - sick sinus syndrome - fetal echocardiography - fetal bradyarrhythmia - congenital heart disease

• References

• 1 Yabek SM, Swensson RE, Jarmakani JM. Electrocardiographic recognition of sinus node dysfunction in children and young adults. Circulation 1977; 56 (02) 235-239
• 2 Yabek SM, Jarmakani JM. Sinus node dysfunction in children, adolescents, and young adults. Pediatrics 1978; 61 (04) 593-598
• 3 Radford DJ, Izukawa T. Sick sinus syndrome. Symptomatic cases in children. Arch Dis Child 1975; 50 (11) 879-885
• 4 Kugler JD, Gillette PC, Mullins CE, McNamara DG. Sinoatrial conduction in children: an index of sinoatrial node function. Circulation 1979; 59 (06) 1266-1276
• 5 Miyoshi T, Maeno Y, Sago H. , et al. Fetal bradyarrhythmia associated with congenital heart defects - nationwide survey in Japan. Circ J 2015; 79 (04) 854-861
• 6 Lin MT, Hsieh FJ, Shyu MK, Lee CN, Wang JK, Wu MH. Postnatal outcome of fetal bradycardia without significant cardiac abnormalities. Am Heart J 2004; 147 (03) 540-544
• 7 Buyon JP, Ben-Chetrit E, Karp S. , et al. Acquired congenital heart block. Pattern of maternal antibody response to biochemically defined antigens of the SSA/Ro-SSB/La system in neonatal lupus. J Clin Invest 1989; 84 (02) 627-634
• 8 Ho SY, Fagg N, Anderson RH, Cook A, Allan L. Disposition of the atrioventricular conduction tissues in the heart with isomerism of the atrial appendages: its relation to congenital complete heart block. J Am Coll Cardiol 1992; 20 (04) 904-910
• 9 Pexieder T. Cell death in the morphogenesis and teratogenesis of the heart. Adv Anat Embryol Cell Biol 1975; 51 (03) 3-99
• 10 Cho MS, Heo R, Jin X. , et al. Sick sinus syndrome after the maze procedure performed concomitantly with mitral valve surgery. J Am Heart Assoc 2018; 7 (19) e009629
• 11 Noda M, Yamaguchi H, Fujii H. , et al. Spontaneous regression over a 16-year period of tachyarrhythmias to sick sinus syndrome and complete atrioventricular block in a young patient with Ebstein's anomaly. Pacing Clin Electrophysiol 2001; 24 (07) 1158-1160