Dextrocardia with complete AV block and the implantation of
Patient was born with SIT and TOF, and the TOF corrective surgery was performed when she was 6 years old. After the operation, she led a peaceful and asymptomatic life. She was pregnant when she was 30 years old, and then she was referred to the Department of Obstetrics in our hospital on December 9, 2017. The patient had a blood pressure of 112/65 mmHg, a pulse rate of 50 beats per minute (bpm), a body temperature of 36.5° C, and a respiratory rate of 18 bpm. At the time of admission, she was pregnant at 38 weeks and 1 day for CS. She had no symptoms of AV block during pregnancy with a heart rate of about 45 bpm. She had chest tightness occasionally when she climbed 3 staircases. Her echocardiogram (ECG) was abnormal, showing atrial fibrillation and 3rd degree AV block.

The AV block was diagnosed only before 3 days of delivery. The average heart rate was 49 bpm, ranging from 39 to 65 bpm. Maternal and fetal B-ultrasound examinations demonstrated that all maternal organs were reversed, while the fetal anatomy was normal. Maternal echocardiography demonstrated no cardiac abnormalities. Her heart function was classified as level I. Obstetric examinations and clinical tests were in the normal ranges. Due to her ECG findings, cardiologist advised us to implant a TPM before delivery via CS. Therefore, a TPM was implanted before delivery on December 15, 2017. She underwent TPM implantation via her left subclavian vein with digital subtraction angiography (DSA) guidance.

The operation was successfully performed in 15 minutes. The pacing threshold was measured at 0.4 V, and the heart rate was at 60 bpm. After successful implantation, CS was performed by continuous epidural anesthesia. A 3410-g healthy female infant was born with Apgar scores of 9 and 9 at 1 and 5 minutes, respectively. After the CS, the TPM was removed. Moreover, 24-hour blood loss was 400 mL after birth. The patient was discharged 4 days postoperatively without any complications. She preferred breastfeeding, and the newborn developed well without any currently known congenital anomalies. She did not treat her 3rd AV block after the delivery. Both mother and child were in good conditions as of now according to the follow-up by telephone.

Source: Medicine: April 2019 - Volume 98 - Issue 17 - p e15211

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