Disproportionate septal hypertrophy associated with erythroblastosis fetalis
B. S. Carter, J. E. DiGiacomo, S. M. Balderston, J. W. Wiggins and G. B. Merenstein
Lubchenco Center for Perinatal Research, University of Colorado School of Medicine, Denver.
We retrospectively reviewed clinical and echocardiographic data on 10
newborns with erythroblastosis fetalis who were admitted to our nurseries
between 1984 and 1988 and who required a double-volume exchange transfusion
and neonatal intensive care. Echocardiograms were performed in the first 48
hours of life. In 5 patients, disproportionate septal hypertrophy was
demonstrated; 1 additional patient had biventricular hypertrophy with a
thickened septum but not disproportionate septal hypertrophy. The mean
septal: left ventricular free-wall ratio for the group (n = 10) was 1.37.
No correlation was apparent between the occurrence of disproportionate
septal hypertrophy and newborn glucose, bilirubin, or hematocrit values.
When analyzed separately, the 4 patients who did not receive intrauterine
blood transfusions had a ratio of 1.73 +/- 0.21 (mean +/- SEM); this was
significantly greater than the ratio in the 6 patients who were transfused
in utero (1.13 +/- 0.24). In patients who underwent transfusions, there was
no correlation between the number of transfusions and the septal:left
ventricular ratio. This study reports a significant but previously
unrecognized cardiac hypertrophy with disproportionate septal hypertrophy
in patients with erythroblastosis fetalis. Our data suggest a sparing
effect of intrauterine fetal transfusions. The mechanism by which these
transfusions may affect the hypertrophic development of the myocardium
remains to be determined.
