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(Circulation. 2002;105:1254.)
© 2002 American Heart Association, Inc.

Images in Cardiovascular Medicine

Calcification of the Atrioventricular Node in a Fetus Affected by Congenital Complete Heart Block

Annalisa Angelini, MD; Giorgio Svaluto Moreolo, MD; Amelia Ruffatti, MD; Ornella Milanesi, MD; Gaetano Thiene, MD

From the Departments of Pathology (A.A., G.T.), Internal Medicine (A.R.), Pediatrics (G.S.M., O.M.), University of Padua Medical School, Padua, Italy.

Correspondence to Gaetano Thiene, MD, Cardiovascular Pathology Unit, Istituto di Anatomia Patologica, Via A. Gabelli, 61, 35100 Padova, Italy. E-mail cardpath{at}unipd.it

At 18 weeks of gestation, a 28-year-old woman with known connective tissue disease had a fetal echocardiogram that showed a complete atrioventricular block and endocardial fibroelastosis of the right ventricle with a focal hyperechogenic area at the crux cordis and mild pericardial effusion (Figure, a). At 22 weeks, the pregnancy was interrupted without complication, and the mother at present is well.

View larger version (91K): [in this window] [in a new window]   a, Horizontal cut of the fetal thorax showing 4-chamber view of the heart. The arrow points to a translucent focus in the A-V region, highly suggestive of a calcification. b, Macroscopic view of the right chambers with evidence of whitish calcium deposits on the endocardial surface. c and d, Histological sections through the atrioventricular node with evidence of calcifications (arrows). c, Hematoxylin Eosin; d, VonKossa Stain. Original magnification x5. e and f, Histological sections of the atrial myocardium with massive inflammatory cell infiltration. e, Hematoxylin eosin; f, Immunohistochemistry for common leucocyte antigens (CD45). Original magnification x20.

Autopsy of the fetus showed no evidence of structural developmental cardiac defects (Figure,b). A lymphocytic myocarditis affecting mainly the atria and calcification of the sinoatrial and atrioventricular nodes were observed as the underlying histological abnormalities responsible for the congenital atrioventricular block (Figure, c through f). No infective agents could be detected by histochemical or immunohistochemical methods (Giemsa, Ziehl-Nielsen, Grocott, PAS, Gram, AntiToxo, anti-CMV).

In this report, we show that congenital complete heart block can be the consequence of fetal autoimmune lymphocytic myocarditis, which may, in turn, result in microcalcific deposits of the atrioventricular node detectable by prenatal 2D echocardiography.

Acknowledgments

This study was supported by a grant from Veneto Region, Venice (Italy).

Footnotes

The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St.Luke's Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.

Circulation encourages readers to submit cardiovascular images to the Circulation Editoral Office, St.Luke's Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MCI-267, Houston, TX 77030.

This Article Extract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Angelini, A. Articles by Thiene, G. Search for Related Content PubMed PubMed Citation Articles by Angelini, A. Articles by Thiene, G. Related Collections Echocardiography Pediatric and congenital heart disease, including cardiovascular surgery