5th International Conference on Heart and Cardiovascular Diseases

Julia Murlewska is affiliated with the Department of Prenatal Cardiology at the Polish Mother’s Memorial Hospital Research Institute, Łódź, Poland. Her academic and clinical work is associated with fetal cardiology, gynecology, obstetrics, and the diagnosis and prevention of fetal malformations.

Background: Complete fetal atrioventricular (AV) block is a rare but potentially life-threatening complication of maternal autoimmune disease. Conventional fetal echocardiography identifies rhythm abnormalities but may not fully characterize the associated myocardial mechanical dysfunction. Fetal speckle-tracking echocardiography offers an advanced approach to assessing myocardial deformation and atrioventricular mechanical relationships.

Objectives: To demonstrate the clinical value of fetal speckle-tracking echocardiography in identifying complete atrioventricular mechanical dissociation and characterizing myocardial dysfunction in a fetus affected by maternal Sjögren’s syndrome.

Methodology: We present a clinical case involving a 31-year-old pregnant woman with Sjögren’s syndrome. Fetal echocardiography was performed at 31 weeks of gestation, followed by advanced speckle-tracking assessment of left and right ventricular shortening fraction across 24 myocardial segments and analysis of atrial and ventricular longitudinal strain patterns.

Key Results/Findings: Conventional echocardiography revealed a prolonged PR interval of 219 ms, fetal bradycardia below 50 beats/min, second-degree AV block with intermittent recovery, mild cardiomegaly, tricuspid regurgitation, and a small pericardial effusion. Speckle-tracking analysis demonstrated markedly reduced myocardial shortening fraction across all ventricular segments, intraventricular mechanical asynchrony, and complete dissociation between atrial and ventricular mechanical activity. Despite prenatal treatment with corticosteroids and hydroxychloroquine, only limited improvement was observed. Delivery occurred at 36 weeks. Postnatally, severe bradycardia and cardiac dysfunction required pharmacological support, followed by permanent pacemaker implantation on day eight of life.

Conclusion: Fetal speckle-tracking echocardiography provides valuable complementary information beyond conventional rhythm assessment by revealing myocardial dysfunction and atrioventricular mechanical dissociation. This case highlights its potential role in comprehensive prenatal cardiac evaluation and multidisciplinary perinatal management of autoimmune-associated fetal heart block.