Hansmann M, Gembruch U, Bald R, Manz M, Redel D A
Department of Prenatal Diagnosis and Therapy, University of Bonn, Germany.
Ultrasound Obstet Gynecol. 1991 May 1;1(3):162-8. doi: 10.1046/j.1469-0705.1991.01030162.x.
From 1981 to 1990, 60 fetuses with tachyarrhythmia (21-39 weeks of gestation) were treated in utero. Of these, 54 were cases of supraventricular tachycardia, and six of atrial flutter. Non-immune fetal hydrops was present in 21 cases with supraventricular tachycardia and in five cases with atrial flutter, a total of 26 cases.Transplacental treatment by maternally administered antiarrhythmic drugs (digoxin only or in combination with verapamil) produced good results in non-hydropic fetuses. In this group, all 34 fetuses survived. In fetuses with hydrops, 20 out of 26 survived. In 13 fetuses of the 26 with hydrops, direct fetal therapy was performed in addition to the transplacental therapy when the tachyarrhythmia was refractory to transplacental treatment. During the 9 years of this study, a variety of direct treatment regimes have been used consisting of intraperitoneal and/or umbilical intravenous administrations of different drugs. Since 1988, umbilical vein punctures have shown that the transplacental passage of digoxin (and amiodarone) is hampered in the presence of hydrops, and direct treatment may he necessary in these cases. Amiodarone seems to he the drug of choice for direct therapy. It is highly effective in supraventricular tachycardia and atrial flutter. The long elimination half-time of amiodarone reduces the number of umbilical cord punctures needed to maintain the therapeutic drug level in the fetus.
1981年至1990年期间，对60例胎儿心律失常（妊娠21 - 39周）进行了宫内治疗。其中，室上性心动过速54例，心房扑动6例。21例室上性心动过速和5例心房扑动胎儿出现非免疫性胎儿水肿，共26例。通过母体给予抗心律失常药物（仅地高辛或与维拉帕米联合使用）进行经胎盘治疗，对非水肿胎儿取得了良好效果。在这组中，所有34例胎儿均存活。在水肿胎儿中，26例中有20例存活。在26例水肿胎儿中的13例中，当心律失常对经胎盘治疗无效时，除经胎盘治疗外还进行了直接胎儿治疗。在这项研究的9年中，使用了多种直接治疗方案，包括腹腔内和/或脐静脉注射不同药物。自1988年以来，脐静脉穿刺显示，在存在水肿的情况下，地高辛（和胺碘酮）的经胎盘转运受到阻碍，在这些情况下可能需要直接治疗。胺碘酮似乎是直接治疗的首选药物。它对室上性心动过速和心房扑动非常有效。胺碘酮的长消除半衰期减少了维持胎儿治疗药物水平所需的脐静脉穿刺次数。
