Am J Cardiol 2000 May 15;85(10):1230-3
1 World experience of percutaneous ultrasound-guided balloon valvuloplasty in human fetuses with severe aortic valve obstruction.

Kohl T, Sharland G, Allan LD, Gembruch U, Chaoui R, Lopes LM, Zielinsky P, Huhta J, Silverman NH. Division of Pediatric Cardiology, University of Munster Medical School, Germany. Prenatal alleviation of severe fetal aortic valve obstructions by percutaneous ultrasound-guided balloon valvuloplasty has been performed to improve the fate of affected fetuses. The purpose of this study was to analyze the current world experience of these procedures in human fetuses. Data from 12 human fetuses were available for analysis. The mean gestational age at intervention was 29.2 weeks (range 27 to 33). The mean time period between initial presentation and intervention was 3.3 weeks (range 3 days to 9 weeks). Technically successful balloon valvuloplasties were achieved in 7 fetuses, none of whom had an atretic valve. Only 1 of these fetuses remains alive today. Of the 5 remaining technical failures, 1 patient with severe aortic stenosis underwent successful postnatal intervention and remains alive. Six patients who survived prenatal intervention died from cardiac dysfunction or at surgery in the first days or weeks after delivery. Four fetuses died early within 24 hours after the procedure, 1 from a bleeding complication, 2 from persistent bradycardias, and 1 at valvotomy after emergency delivery. Thus, the early clinical experience of percutaneous ultrasound-guided fetal balloon valvuloplasty in human fetuses with severe aortic valve obstruction has been poor due to selection of severe cases, technical problems during the procedure, and high postnatal operative mortality in fetuses who survived gestation. Improved patient selection and technical modifications in interventional methods may hold promise to improve outcome in future cases.

Arq Bras Cardiol 1997 Sep;69(3):219-22
2 Fetal arrhythmias.

[Article in Portuguese]
Lopes LM, Zugaib M.
Hospital das Clinicas, Faculdade de Medicina, USP.
PMID: 9595737 [PubMed – indexed for MEDLINE]

Fetal Diagn Ther 1996 Jul-Aug;11(4):296-300
3 Balloon dilatation of the aortic valve in the fetus. A case report.

Lopes LM, Cha SC, Kajita LJ, Aiello VD, Jatene A, Zugaib M.
DOG-FMUSP, Sao Paulo SP, Brazil.
Fetal echocardiography has recently caused an impact on the treatment of congenital heart disease and in the field of therapeutic, cardiological intervention. The present study reports on a case of critical aortic stenosis, diagnosed in utero at 27 weeks’ gestation, and in which balloon dilatation was attempted to improve the poor prognosis associated with this condition. Since the endocardium at this stage of development was apparently normal, this therapeutic intervention was attempted to avoid irreversible damage to the left ventricle. Although hydrops disappeared and the myocardium hypertrophied, endocardial fibroelastosis progressed and the neonate died within the first day of life, after surgical aortic valvotomy. More data are necessary to clarify whether endocardial fibroelastosis is really a consequence of high pressure in the left ventricle resulting from stenosis of the aortic valve or whether it is a disease, the progression of which is unavoidable once it takes hold.
PMID: 8823612 [PubMed – indexed for MEDLINE]

Pediatr Cardiol 1996 May-Jun;17(3):192-3
4 Fetal idiopathic ventricular tachycardia with nonimmune hydrops: benign course.

Lopes LM, Cha SC, Scanavacca MI, Tuma-Calil VM, Zugaib M. Division of Fetal Medicine, Department of Obstetrics and Gynecology, Sao Paulo University School of Medicine, Sao Paulo, Brazil.

A case of idiopathic ventricular tachycardia of left ventricular origin in a hydropic fetus is presented. The accuracy of fetal echocardiography for diagnosing this type of arrhythmia is emphasized, as is its importance in determining appropriate postnatal treatment which in this case resulted in an unusually benign course.

PMID: 8662035 [PubMed – indexed for MEDLINE]

Prenat Diagn 1995 Feb;15(2):183-5
5 Echocardiographic diagnosis of fetal Marfan syndrome at 34 weeks’ gestation.

Lopes LM, Cha SC, de Moraes EA, Zugaib M.
Department of Obstetrics and Gynecology, Sao Paulo University School of Medicine, Brazil.
Fetal echocardiography was performed during the third trimester in a normal primigravida. The fetal heart was severely affected with the typical cardiac manifestations of Marfan syndrome. The medical history of the father was investigated and a mild form of the syndrome was diagnosed. The neonate died at 2 months of age of congestive heart failure.
PMID: 7784372 [PubMed – indexed for MEDLINE]

Arq Bras Cardiol 1994 Oct;63(4):297-8
6 Use of sympathomimetic agents in fetal atrioventricular heart block.

Lopes LM, Cha SC, Leone C, Zugaib M.
Hospital das Clinicas da Faculdade de Medicina-USP, Sao Paulo.
A healthy pregnant was referred at 34 weeks gestation because an obstetrical ultrasound examination had shown fetal bradycardia and nonimmune hydrops. The heart was anatomically normal but complete heart block was present with a ventricular rate of 22bpm and atrial of 101bpm. We injected isoproterenol by cordocentesis direct in the umbilical vein of the fetus and a significant increase into the ventricular and atrial rates were obtained. The direct therapy with sympathomimetic drugs is a simple technique and may save fetuses with complete heart block and hidrops.
PMID: 7771947 [PubMed – indexed for MEDLINE]

Arq Bras Cardiol 1992 Oct;59(4):261-4
7 Fetal atrioventricular block.

Lopes LM, Cha SC, Sadek L, Iwahashi ER, Aiello VD, Zugaib M.
Departamento de Obstetricia e Ginecologia, Hospital das Clinicas, FMUSP.
PURPOSE–To study the pathogenesis, evolution and prognosis of the complete heart block of the fetus. METHODS–Bidimensional echocardiography associated to M-mode and doppler was performed in 600 patients. All cases of congenital heart block were referred because the fetuses presented hydrops, bradycardia and/or cardiac malformation suspected by routine ultrasound. RESULTS–Isolated heart block was found in 6 fetuses (5 cases of complete type and 1 case of 2nd degree type 2:1). Heart block associated with complex cardiac disease and left atrial isomerism was found in 6 fetuses with no survivors (5 cases of complete type and 1 case of 2nd degree type 2:1). Heart block associated with atrioventricular discordante was found in 1 case. CONCLUSION–The findings of this study agree the literature about the relation between maternal anti-RO antibodies and isolated complete heart block. We also found a poor prognosis in the group with heart block and complex cardiac malformations.
PMID: 1341181 [PubMed – indexed for MEDLINE]

Arq Bras Cardiol 1990 Feb;54(2):121-5
8 Prenatal diagnosis of congenital heart diseases and cardiac arrhythmias by Doppler echocardiography.

Lopes LM, Kahhale S, Barbato A, Magalhaes A, Aiello VD, Zugaib M. Departamento de Obstricia e Ginecologia da Faculdade de Medicina da USP.
PURPOSE–To detect in prenatal life fetal arrhythmia and congenital heart disease. We performed fetal echocardiography following classical indications according to the literature. PATIENTS AND METHODS–Two-dimensional echocardiography associated with M-mode and Doppler was performed in 200 patients according to the indications: maternal diabetes, fetal arrhythmia, maternal congenital heart disease, previous fetus with cardiac defect, intrauterine growth retardation, nonimmune fetal hydrops, rubeola, isoimmunization, fetal malformation by ultrasound, polyhydramnios, gemelarity, oligohydramnios, maternal ingestion of drugs, lupus and others. RESULTS–Structural abnormalities of the heart were found in 6 cases and associated with bradiarrhythmia in 5 cases (total of 5.5%). Fetal arrhythmias without cardiac malformation were found in 35 cases (17.5%) and premature atrial contractions were the most frequent. CONCLUSION–The findings in this study indicate that it is possible the accurate definition of the cardiac anatomy and function. We have emphasized the method trying to spread it, objecting to improve assistance to the fetus and newborn with arrhythmias and/or congenital heart disease.

PMID: 2260936 [PubMed – indexed for MEDLINE]