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Transplacental digoxin therapy for fetal tachyarrhythmia with multiple evaluation systems
Kaiyu Zhou1, Yimin Hua, Qi Zhu
1Department of Pediatric Cardiology, West China Second University Hospital and West China Medical School, Sichuan University, Chengdu, 610041, China.
Summary
Transplacental digoxin effectively treats fetal tachyarrhythmia, restoring sinus rhythm and improving cardiac function. This therapy, monitored with multiple evaluation systems, shows favorable neonatal outcomes and no long-term developmental issues.
Area of Science:
- Perinatology
- Maternal-Fetal Medicine
- Pediatric Cardiology
Background:
- Sustained fetal tachyarrhythmia poses risks including heart failure, hydrops fetalis, and fetal demise.
- Timely and effective therapeutic interventions are crucial for managing fetal tachyarrhythmia.
Observation:
- Four cases of fetal tachyarrhythmia were diagnosed via fetal echocardiography.
- Transplacental digoxin therapy was initiated at 0.25 mg daily, with regular monitoring of maternal serum digoxin levels and fetal echocardiography.
- Cardiac function was assessed using the Tei index, cardiovascular profile score (CVPS), and umbilical artery resistance index (UARI).
Findings:
- Digoxin treatment led to improved CVPS and reduced Tei index and UARI, indicating cardiac function recovery.
- Sinus rhythm was restored within 3-42 days.
- Placental digoxin transport efficiency ranged from 76.45-84.31%, with favorable neonatal conditions and no observed reoccurrence of arrhythmia or developmental deficits during follow-up.
Implications:
- Transplacental digoxin therapy, guided by combined evaluations of Tei index, CVPS, and UARI, is a valuable treatment for fetal atrial flutter and supraventricular tachycardia.
- This approach facilitates successful management of fetal tachyarrhythmias, leading to positive neonatal outcomes.
- The study supports the use of digoxin for fetal cardiac rhythm management, emphasizing the importance of integrated monitoring systems.
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