Wiggins J W, Bowes W, Clewell W, Manco-Johnson M, Manchester D, Johnson R, Appareti K, Wolfe R R
Am J Dis Child. 1986 Mar;140(3):202-4. doi: 10.1001/archpedi.1986.02140170028022.
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.
胎儿超声心动图现在能够对继发于胎儿心律失常和/或某些类型先天性心脏病的非免疫性胎儿水肿做出准确的临床诊断。已有个别病例报告了使用包括地高辛、盐酸普萘洛尔、盐酸普鲁卡因胺以及地高辛加盐酸维拉帕米等各种药物治疗心律失常的情况。我们未发现关于对窦性心律的先天性心脏病所致充血性心力衰竭进行宫内治疗的报告。本文介绍的7例病例包括5例孤立性室上性心动过速、1例室上性心动过速合并心肌肿瘤以及1例先天性心脏病合并充血性心力衰竭。母亲使用地高辛治疗使所有6例胎儿的心律失常转为窦性心律，并使患有先天性心脏病的胎儿的水肿消退。7例中有5例避免了早产，6例预后良好。在5例接受口服洋地黄化的母亲中，胎儿对治疗的反应延迟（3至35天）。2例母亲接受静脉治疗，胎儿在不到24小时内对治疗产生反应。由于可能与地高辛吸收不良和/或清除过快有关的问题，静脉给药途径应作为在胎儿中达到足够治疗水平的最佳方法。
