New electrode for pacing fetuses with complete heart block
Autor(a) principal: | |
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Data de Publicação: | 2003 |
Outros Autores: | , , , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Brazilian Journal of Cardiovascular Surgery (Online) |
Texto Completo: | http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0102-76382003000100009 |
Resumo: | OBJECTIVE: As fetal complete heart block with hydrops carries a poor prognosis, intrauterine pacing appears the most logical treatment. However, premature labor following hysterotomy remains a major obstacle to open procedures. Therefore, we developed a new lead for fetal pacing that avoids the need for intrauterine open surgical procedures. METHODS We successfully implanted a new T-bar-shaped lead into the myocardium of a fetus at 25 weeks gestation presenting with complete heart block (heart rate = 47 beats per minute), hydrops, and structural heart defects. The procedure was performed under ultrasound guidance, and the lead was introduced through the tip of a specially designed, 18G needle. The new lead was then connected to a Biotronik Actros pulse generator, which was implanted subcutaneously in the maternal abdominal wall. RESULTS: The stimulation resistance was 357 omega, and the sensed fetal R wave was 6.4 mV. The voltage strength-duration curve remained relatively constant at pulse widths > 0.6 msec. An echocardiogram on the first postoperative day revealed a mild pericardial effusion. The fetal heart rate was sTable , with low stimulation thresholds and no stimulation failures. No uterine contractions were observed during the postoperative period. However, the fetus died 36 hours after the procedure, probably due to cardiac tamponade. CONCLUSION: To our knowledge, this is the first documentation of voltage strength-duration curves for the acute myocardial stimulation threshold of a human fetus that survived 36 hours after intrauterine pacemaker implantation. This case emphasizes that percutaneous fetal pacing with the new lead is feasible and may minimize the chances of premature labor. |
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Brazilian Journal of Cardiovascular Surgery (Online) |
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New electrode for pacing fetuses with complete heart blockCardiac surgical proceduresHeart block/surgeryPacemaker artificialHydrops fetalisOBJECTIVE: As fetal complete heart block with hydrops carries a poor prognosis, intrauterine pacing appears the most logical treatment. However, premature labor following hysterotomy remains a major obstacle to open procedures. Therefore, we developed a new lead for fetal pacing that avoids the need for intrauterine open surgical procedures. METHODS We successfully implanted a new T-bar-shaped lead into the myocardium of a fetus at 25 weeks gestation presenting with complete heart block (heart rate = 47 beats per minute), hydrops, and structural heart defects. The procedure was performed under ultrasound guidance, and the lead was introduced through the tip of a specially designed, 18G needle. The new lead was then connected to a Biotronik Actros pulse generator, which was implanted subcutaneously in the maternal abdominal wall. RESULTS: The stimulation resistance was 357 omega, and the sensed fetal R wave was 6.4 mV. The voltage strength-duration curve remained relatively constant at pulse widths > 0.6 msec. An echocardiogram on the first postoperative day revealed a mild pericardial effusion. The fetal heart rate was sTable , with low stimulation thresholds and no stimulation failures. No uterine contractions were observed during the postoperative period. However, the fetus died 36 hours after the procedure, probably due to cardiac tamponade. CONCLUSION: To our knowledge, this is the first documentation of voltage strength-duration curves for the acute myocardial stimulation threshold of a human fetus that survived 36 hours after intrauterine pacemaker implantation. This case emphasizes that percutaneous fetal pacing with the new lead is feasible and may minimize the chances of premature labor.Sociedade Brasileira de Cirurgia Cardiovascular2003-10-01info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersiontext/htmlhttp://old.scielo.br/scielo.php?script=sci_arttext&pid=S0102-76382003000100009Brazilian Journal of Cardiovascular Surgery v.18 n.1 2003reponame:Brazilian Journal of Cardiovascular Surgery (Online)instname:Sociedade Brasileira de Cirurgia Cardiovascular (SBCCV)instacron:SBCCV10.1590/S0102-76382003000100009info:eu-repo/semantics/openAccessAssad,Renato S.Zielinsky,PauloKalil,RenatoLima,GustavoAramayo,AnnaSantos,AriCosta,RobertoBarbero-Marcial,MiguelOliveira,Sérgio A.eng2003-08-05T00:00:00Zoai:scielo:S0102-76382003000100009Revistahttp://www.rbccv.org.br/https://old.scielo.br/oai/scielo-oai.php||rosangela.monteiro@incor.usp.br|| domingo@braile.com.br|| brandau@braile.com.br1678-97410102-7638opendoar:2003-08-05T00:00Brazilian Journal of Cardiovascular Surgery (Online) - Sociedade Brasileira de Cirurgia Cardiovascular (SBCCV)false |
dc.title.none.fl_str_mv |
New electrode for pacing fetuses with complete heart block |
title |
New electrode for pacing fetuses with complete heart block |
spellingShingle |
New electrode for pacing fetuses with complete heart block Assad,Renato S. Cardiac surgical procedures Heart block/surgery Pacemaker artificial Hydrops fetalis |
title_short |
New electrode for pacing fetuses with complete heart block |
title_full |
New electrode for pacing fetuses with complete heart block |
title_fullStr |
New electrode for pacing fetuses with complete heart block |
title_full_unstemmed |
New electrode for pacing fetuses with complete heart block |
title_sort |
New electrode for pacing fetuses with complete heart block |
author |
Assad,Renato S. |
author_facet |
Assad,Renato S. Zielinsky,Paulo Kalil,Renato Lima,Gustavo Aramayo,Anna Santos,Ari Costa,Roberto Barbero-Marcial,Miguel Oliveira,Sérgio A. |
author_role |
author |
author2 |
Zielinsky,Paulo Kalil,Renato Lima,Gustavo Aramayo,Anna Santos,Ari Costa,Roberto Barbero-Marcial,Miguel Oliveira,Sérgio A. |
author2_role |
author author author author author author author author |
dc.contributor.author.fl_str_mv |
Assad,Renato S. Zielinsky,Paulo Kalil,Renato Lima,Gustavo Aramayo,Anna Santos,Ari Costa,Roberto Barbero-Marcial,Miguel Oliveira,Sérgio A. |
dc.subject.por.fl_str_mv |
Cardiac surgical procedures Heart block/surgery Pacemaker artificial Hydrops fetalis |
topic |
Cardiac surgical procedures Heart block/surgery Pacemaker artificial Hydrops fetalis |
description |
OBJECTIVE: As fetal complete heart block with hydrops carries a poor prognosis, intrauterine pacing appears the most logical treatment. However, premature labor following hysterotomy remains a major obstacle to open procedures. Therefore, we developed a new lead for fetal pacing that avoids the need for intrauterine open surgical procedures. METHODS We successfully implanted a new T-bar-shaped lead into the myocardium of a fetus at 25 weeks gestation presenting with complete heart block (heart rate = 47 beats per minute), hydrops, and structural heart defects. The procedure was performed under ultrasound guidance, and the lead was introduced through the tip of a specially designed, 18G needle. The new lead was then connected to a Biotronik Actros pulse generator, which was implanted subcutaneously in the maternal abdominal wall. RESULTS: The stimulation resistance was 357 omega, and the sensed fetal R wave was 6.4 mV. The voltage strength-duration curve remained relatively constant at pulse widths > 0.6 msec. An echocardiogram on the first postoperative day revealed a mild pericardial effusion. The fetal heart rate was sTable , with low stimulation thresholds and no stimulation failures. No uterine contractions were observed during the postoperative period. However, the fetus died 36 hours after the procedure, probably due to cardiac tamponade. CONCLUSION: To our knowledge, this is the first documentation of voltage strength-duration curves for the acute myocardial stimulation threshold of a human fetus that survived 36 hours after intrauterine pacemaker implantation. This case emphasizes that percutaneous fetal pacing with the new lead is feasible and may minimize the chances of premature labor. |
publishDate |
2003 |
dc.date.none.fl_str_mv |
2003-10-01 |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0102-76382003000100009 |
url |
http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0102-76382003000100009 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
10.1590/S0102-76382003000100009 |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
text/html |
dc.publisher.none.fl_str_mv |
Sociedade Brasileira de Cirurgia Cardiovascular |
publisher.none.fl_str_mv |
Sociedade Brasileira de Cirurgia Cardiovascular |
dc.source.none.fl_str_mv |
Brazilian Journal of Cardiovascular Surgery v.18 n.1 2003 reponame:Brazilian Journal of Cardiovascular Surgery (Online) instname:Sociedade Brasileira de Cirurgia Cardiovascular (SBCCV) instacron:SBCCV |
instname_str |
Sociedade Brasileira de Cirurgia Cardiovascular (SBCCV) |
instacron_str |
SBCCV |
institution |
SBCCV |
reponame_str |
Brazilian Journal of Cardiovascular Surgery (Online) |
collection |
Brazilian Journal of Cardiovascular Surgery (Online) |
repository.name.fl_str_mv |
Brazilian Journal of Cardiovascular Surgery (Online) - Sociedade Brasileira de Cirurgia Cardiovascular (SBCCV) |
repository.mail.fl_str_mv |
||rosangela.monteiro@incor.usp.br|| domingo@braile.com.br|| brandau@braile.com.br |
_version_ |
1752126595000172544 |