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01. History of Cardiology
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31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
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34. Public Health and Health Economics
35. Research Methodology
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Refractory fetal and neonatal supraventricular tachycardia associated with mitral valve mass
Session:
Casos Clínicos desafiantes 1
Speaker:
Marisa Pereira
Congress:
CPC 2023
Topic:
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Theme:
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Subtheme:
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Session Type:
Speaker´s Corner
FP Number:
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Authors:
Marisa Pereira; Catarina Almeida; João Sarmento; Joana Miranda
Abstract
<p style="text-align:justify"><span style="font-size:20px"><span style="font-family:Calibri,"sans-serif""><span style="font-family:"Calibri Light","sans-serif"">Primary cardiac tumors in children are rare and mostly benign, however they can be associated with serious cardiovascular complications, including clinically significant arrhythmias. They produce a wide variety of arrhythmias, including low-grade ectopic, pre-excitation and sustained supraventricular tachycardia (SVT), non-sustained and sustained ventricular tachycardia and sudden cardiac arrest. The optimal approach for pediatric patients with cardiac tumors remains unclear, particularly when severe arrhythmias are present.</span></span></span></p> <p style="text-align:justify"><span style="font-size:20px"><span style="font-family:Calibri,"sans-serif""><span style="font-family:"Calibri Light","sans-serif"">We present a case of prenatal diagnosis (28 weeks of gestation) of SVT associated with a mitral valve mass and fetal hydrops. Transplacental treatment was performed with digoxin and flecainide for 14 days, followed by amiodarone. However, due to persistent fetal arrhythmia and maternal pharmacological toxicity, delivery by cesarean-section was performed at 30 weeks. The female newborn, weighing 2000g, presented SVT resistant to chemical cardioversion with adenosine and amiodarone. On day-2 of life, a wide complex tachycardia episode was recorded, with no sustained reversal after synchronized electrical cardioversion, so lidocaine was associated. Persistent sinus rhythm was restored on day 9, at which time oral propranolol was started after amiodarone and lidocaine discontinuation. On day-42, after 5 days with frequent premature atrial contractions, she restarted incessant SVT, requiring new chemical cardioversion and subsequent management with propranolol and flecainide. She has maintained sinus rhythm since day-53. The echocardiogram presented a mass in the anterior leaflet of the mitral valve, without flow obstruction nor regurgitation. A computed tomography was performed (day-54) and detected both cardiac and liver mass, with similar characteristics and compatible with hemangiomas. Both showed involution during hospitalization, coinciding with improvement in the rhythm.</span></span></span></p> <p style="text-align:justify"><span style="font-size:20px"><span style="font-family:Calibri,"sans-serif""><span style="font-family:"Calibri Light","sans-serif"">The infant was discharged on day-67 with propranolol and flecainide. She remained asymptomatic with no documented episodes of SVT on regular ECG nor on 24-hour Holter monitoring.</span></span></span></p> <p style="text-align:justify"><span style="font-size:20px"><span style="font-family:"Calibri Light","sans-serif"">We report a rare case of fetal and neonatal sustained SVT associated with a mitral hemangioma, which was medically controlled. Yet, it was associated with neonatal complications (prematurity, anemia, bronchopulmonary dysplasia and probably iatrogenic hypothyroidism) and maternal complications (pharmacological toxicity by digoxin and amiodarone). Further follow-up is required to evaluate the duration of therapy as well as the characteristics and evolution of the cardiac hemangioma.</span></span></p>
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