Echocardiographic diagnosis and intravenous digoxin management of fetal tachyarrhythmias and congestive heart failure
J. W. Wiggins Jr, W. Bowes, W. Clewell, M. Manco-Johnson, D. Manchester, R. Johnson, K. Appareti and R. R. Wolfe
Fetal echocardiography now affords an accurate clinical diagnosis of
nonimmune fetal hydrops secondary to fetal tachyarrhythmias and/or certain
types of congenital heart disease. Individual case reports of the treatment
of tachyarrhythmias have been reported that use various drugs, including
digoxin, propranolol hydrochloride, procainamide hydrochloride, and digoxin
plus verapamil hydrochloride. We found no report of intrauterine treatment
of congestive heart failure due to congenital heart disease with sinus
rhythm. The seven cases presented herein include five cases of isolated
supraventricular tachycardia, one with supraventricular tachycardia and
myocardial tumors, and one of congenital heart disease with congestive
heart failure. Maternal treatment with digoxin converted tachyarrhythmia to
sinus rhythm in all six fetuses, and resolved the hydrops in the fetus with
congenital heart disease. Premature delivery was avoided in five of the
seven cases with favorable outcome in six of the cases. In five mothers who
were given oral digitalization, the fetuses had delayed (three to 35 days)
response to therapy. Two mothers were treated intravenously and the fetus
responded to therapy in less than 24 hours. Because of problems possibly
related to poor absorption and/or rapid clearance of digoxin, the
intravenous route of administration should be used as the best way to
achieve adequate therapeutic levels in the fetus.
