Congenital complete heart block and maternal connective tissue disease

Jayaprasad, N.; Francis, Johnson; Venugopal, K.

doi:10.1016/j.ijcard.2005.11.115

Cited by 35 publications

(34 citation statements)

References 56 publications

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“…An example is that of congenital heart block that occurs in the absence of structural abnormalities in a small percentage of infants born to mothers with systemic lupus erythematosus (Jayaprasad et al, 2006). In this case, placental transfer of anti-Ro/La antibodies from mothers to fetus results in fetal cardiac toxicity.…”

Section: Discussionmentioning

confidence: 99%

“…Although irreversible developmental toxicities have not yet been observed for any of the therapeutic mAbs, it is possible for an antibody to produce an irreversible toxicity in the fetus that does not occur in adults. An example is that of congenital heart block that occurs in the absence of structural abnormalities in a small percentage of infants born to mothers with systemic lupus erythematosus (Jayaprasad et al, 2006). In this case, placental transfer of anti-Ro/La antibodies from mothers to fetus results in fetal cardiac toxicity.…”

Section: Discussionmentioning

confidence: 99%

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Considerations in assessing the developmental and reproductive toxicity potential of biopharmaceuticals

Martin¹,

Breslin

Rocca

et al. 2009

Birth Defects Research Pt B

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This report discusses the principles of developmental and reproductive toxicity (DART) testing for biopharmaceuticals. Biopharmaceuticals are large‐molecular‐weight proteins or peptides produced by modern biotechnology techniques incorporating genetic engineering and hybridoma technologies. The principles of DART testing for biopharmaceuticals are similar to those for small‐molecule pharmaceuticals and in general follow the regulatory guidance outlined in International Conference on Harmonisation of Technical Requirements for Registration of Pharmaceuticals for Human Use (ICH) document S5(R2). However, because many biopharmaceuticals are species‐specific, alternate approaches may be needed to evaluate DART potential as outlined in ICH S6. For molecules that show species‐specific cross‐reactivity restricted to non‐human primates (NHP), some aspects of DART may require NHP testing. For biopharmaceuticals that are uniquely specific and only active on intended human targets or human and chimpanzee targets, surrogate molecules that cross‐react with the more traditional rodent species may need to be developed and used for DART testing. Alternatively, genetically modified transgenic animals may also need to be considered. Surrogate molecules and transgenic animals may also be considered for DART testing even if the biopharmaceutical is active in NHPs in order to reduce the use of NHPs. Because of the unique properties of biopharmaceuticals, a case‐by‐case approach is needed for DART and general toxicity evaluation, which requires consideration of specific product attributes including biochemical and biophysical characteristics, pharmacological activity, and intended clinical indication. Birth Defects Res (Part B), 33:176–203, 2009. © 2009 Wiley‐Liss, Inc.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Considerations in assessing the developmental and reproductive toxicity potential of biopharmaceuticals

Martin¹,

Breslin

Rocca

et al. 2009

Birth Defects Research Pt B

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“…Early pacemaker therapy is indicated in patients with symptomatic bradycardia and ventricular dysfunction. The indications for pacing in CHB continue to evolve with advances in techniques and most of these children will ultimately require permanent pacemakers by adulthood [79][80][81][82][83][84]. The cardiac evaluation of these fetuses is difficult as the ventricular rate is low and the heart is dilated.…”

Section: Embryology Anatomy and Pathophysiology Of Fetal Heart And mentioning

confidence: 99%

Advances in fetal cardiology

Comparetto

Borruto

2014

Evidence Based Womenʼs Health Journal

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The prevalence of congenital heart malformations as a whole (including diseases of little clinical significance) is 0.8% (8 of 1000 live births). The most frequent pathologies are malformations that prevent blood from reaching the lungs to take oxygen or block the normal supply of oxygenated blood to the body. The transposition of the great vessels (the aorta and pulmonary artery originate from the 'wrong' ventricles) is important as it represents the most severe neonatal heart disease. A separate issue, instead, is that of arrhythmias. The diagnosis is made around the 20th-21st week of gestation through a targeted ultrasound examination of fetal heart. This enables the recognition of the vast majority (around 85%) of clinically important congenital heart diseases (CHD) at birth. Nevertheless, targeted examinations are not possible for all pregnancies: the costs would not allow it. They are still available for patients who have recognized risk factors (they had children with previous CHD, they took teratogenic drugs, or they have diabetes), whereas pregnant women who have a very low risk are subjected to basic ultrasound examinations. An ultrasound examination allows at least suspicion of a significant proportion (30-40%) of important heart diseases. Progresses in the diagnostic field are continuous and the development of visualization techniques provides great opportunities. Four-dimensional (4-D) ultrasound that allows volumetrical viewing of the fetus, moving, to the most detailed facial expressions, appears to be promising in the diagnosis of CHD, which often escape the traditional ultrasound examination. Enabling better visualization of the heart, thanks to the ability to view it from different points and angles, volumetric ultrasound could aid the diagnosis of more heart diseases. Recognition of fetuses with heart disease may be useful for planning targeted interventions. The purpose of prenatal diagnosis is, first, to improve the prognosis without serious damages in the neonatal period. If necessary, there is the possibility of interventions on the fetus (which mainly consists of aortic or pulmonary valve and foramen ovale dilation), but they are still experimental cardiac procedures. In general, the first interventions take place on the newborn baby; therefore, the birth can be arranged at a cardiology and cardiac surgery unit, thus avoiding delays and dangerous transfers. Thanks to the timely diagnosis, today, 90% of operated babies survive and reach adulthood with a normal life expectancy (only for patients with univentricular heart, we impose limits on physical and working activity). Today, complex operations are possible even in low-birth-weight babies, with very good results, attempting to prioritize corrective radical rather than palliative solutions, which until recently were often the only options. As medical therapies play a marginal role in heart malformations, they are instead essential in the treatment of fetal tachyarrhythmias: these are quite rare diseases, which are also detectable by echoc...

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“…5 Although it can occur as an isolated defect or in association with tumors like mesothelioma, 6 and with complex structural heart disease such as heterotaxias and congenitally-corrected l-transposition of the great arteries, 7 the large majority of CHB cases (60–90%) presenting in utero or in the neonatal period are due to maternal antibodies that cross the placenta in neonatal lupus. 8,9 Fetal echocardiography has allowed the prenatal diagnosis of CHB to be made routinely. 10 …”

Section: Introductionmentioning

confidence: 99%

Cardiac Manifestations of Neonatal Lupus

Capone

Buyon

Friedman

et al. 2012

Cardiology in Review

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Within the last decade the prevalence of adult patients living with congenital heart disease equals that seen in children. This expanding population poses a challenge to clinical cardiologists who will be caring for patients with the clinical manifestations of this condition. Neonatal lupus is a model of passively acquired auto-immunity and is responsible for the majority of clinical cases of congenital heart block. This review will focus on the presentation, pathophysiology, and the long-term follow up of congenital heart block associated with neonatal lupus, as well as discuss important diagnostic tests, familial implications, and pacemaker issues associated with the care of an adult with congenital heart block.

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Congenital complete heart block and maternal connective tissue disease

Cited by 35 publications

References 56 publications

Considerations in assessing the developmental and reproductive toxicity potential of biopharmaceuticals

Considerations in assessing the developmental and reproductive toxicity potential of biopharmaceuticals

Advances in fetal cardiology

Cardiac Manifestations of Neonatal Lupus

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