Congenital hydrops and WPW syndrome

Abstract

The mother, a 24-year-old primigravida, noticed a sudden disappearance of fetal movements at the 34th week of an uneventful pregnancy . The next day, the fetal heart rate was found to be about 200/min and she was admitted . A few hours later the tachycardia rose to 240/min, prompting preparations for an emergency cesarean section, as cardiac origin of the fetal tachyarrhythmia was suspected . At the time of maternal anesthesia the fetal heart rate dropped suddenly to 156/min . There was no hydramnios and the placenta (434 g) was normal . A 2480-g male infant was delivered, Apgar 3-7-8 . He was cyanotic with bradycardia and no spontaneous respiration . He was intubated immediately and ventilated with pure oxygen . His color improved rapidly and he showed spontaneous movements after 4 min . He was kept intubated and ventilated during referral to our neonatal ICU . On admission the baby was hydropic (generalized body edema), heart rate was 134/min, blood pressure 48/20 mmHg, and temperature 36 .4°C. There was no heart murmur . Physical examination of the abdomen revealed massive edema and ascites . The liver was 2 cm below the right costal margin and the spleen was not palpable . No obvious malformations were seen . Neurologically the infant appeared normal . A moderately enlarged heart, signs of pulmonary perivascular edema, fluid in the lung fissures, considerable bilateral pleural effusions, and ascites were found on x-ray examinations . Arterial blood gases were : pH 7.26, PaCO2 31 mmHg, BE -13.0 mmol/liter, PaO2 73 mmHg (FIO2 1 .0) ; total serum proteins 42 g/liter ; all other investigated biochemical parameters were within the normal range . Results of bacteriological and virological examinations remained negative. An ECG showed a typical WPW pattern and echocardiography was normal . The infant remained intubated and ventilated with F10 2 over 0.8 during the first 24 h . Edema was treated with salt-poor albumin and furosemide . The weight dropped from 2480 g to 2010 g . Arterial blood gases improved as edema decreased and at 58 h of age the child was extubated . During the first two weeks of life the heart rate remained between 120 and 156/min . At the age of 14 days, the first extrauterine episode of supraventricular tachycardia with a heart rate of 300/min was noticed . Digitalization brought back sinus rhythm 2 h after the loading dose . The further history was uneventful and he was discharged home on day 24 (weight 2470 g) . Pediatric Cardiology

DOI: 10.1007/BF02282749

Cite this paper

@article{Lauener1985CongenitalHA, title={Congenital hydrops and WPW syndrome}, author={P Lauener and Maurice Payot and J. -L. Micheli}, journal={Pediatric Cardiology}, year={1985}, volume={6}, pages={113-114} }