[RHEUMATOLOGY IN PEDIATRIC CARDIOLOGY FROM FETAL STAGE TO ADULTHOOD. THE ROLE OF FETAL ECHOCARDIOGRAPHY].

Abstract

Even though in the last ten years pediatric cardiology and rheumatology have formally separated in Croatia as well, strong links still remain between them. They are no longer manifested through rheumatic fever, but through other rheumatic entities: systemic lupus erythematosus, antiphospholipid syndrome, systemic scleroderma, Kawasaki disease, polyarteritis nodosa, and some forms of granulomatous vasculitis. We take special note of the occurrence of complete congenital atrioventricular block (CCAVB) in pregnant women who, due to systemic connective tissue diseases, develop distinctive ANA antibodies (anti-SSA/Ro and/or anti SSB/La), but who are also likely to have the same inflammation within the heart, leading to the development of restricted cardiomyopathy associated with CCAVC. Although rheumatology has thus been involved with early fetal age for some time now, there are also some issues relating to the embryonal stage (the association between methotrexate/folic acid and heart development in embryos), as well as to the late fetal stage (antiprostaglandin anti-infl ammatory agent impact on premature ductus arteriosus closure). We gave special attention to the neonatal lupus syndrome, the most serious complication in the fetal period. Thus the multiple association between cardiology and rheumatology in all age groups, from the embryonal and fetal stage to adulthood, is being realized. The aim of this paper is to present some important links and thus further emphasize the new cooperation between pediatric cardiology and rheumatology from fetal stage to adulthood.