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Echocardiographic Diagnosis and Intravenous Digoxin Management of Fetal Tachyarrhythmias and Congestive Heart Failure
James W. Wiggins, Jr, MD;
Watson Bowes, MD;
William Clewell, MD;
Michael Manco-Johnson, MD;
David Manchester, MD;
Robert Johnson, MD;
Kevin Appareti, RDMS;
Robert R. Wolfe, MD
Am J Dis Child. 1986;140(3):202-204.
Abstract
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• 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.
(AJDC 1986;140:202-204)
Author Affiliations
From the Departments of Pediatrics (Drs Wiggins, Manchester, and Wolfe), Obstetrics and Gynecology (Drs Clewell and Johnson), and Radiology (Dr Manco-Johnson and Mr Appareti), University of Colorado School of Medicine, Denver; and the Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill (Dr Bowes).
Footnotes
Accepted for publication Sept 4, 1985.
Read before the American Academy of Pediatrics Section on Cardiology Meeting, New Orleans, Oct 30, 1981.
Reprint requests to University of Colorado School of Medicine, 4200 E Ninth Ave, Box C220, Denver, CO 80262 (Dr Wiggins).
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