Digoxin for the treatment of fetal congestive heart failure with sinus rhythm assessed by cardiovascular profile score

Patel, Dhaval; Cuneo, Bettina F.; Viesca, Regina; Rassanan, Juha; Leshko, Jenny; Huhta, James C.

doi:10.1080/14767050802073790

Cited by 33 publications

(12 citation statements)

References 22 publications

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“…439 Finally, fetal transplacental digoxin may improve signs of heart failure in select cases. 465 The potential impact of prenatal diagnosis and management for other conditions associated with the evolution of fetal heart failure and sudden demise, including Ebstein anomaly, TOF with absent pulmonary valve, and other less common lesions, has not, to date, been fully evaluated. Limited patient numbers at any single institution and significant variability in management algorithms from one institution to another contribute to the challenges of documenting improvements in morbidity and mortality.…”

Section: Impact On Survivalmentioning

confidence: 99%

See 1 more Smart Citation

Diagnosis and Treatment of Fetal Cardiac Disease

Donofrio¹,

Moon-Grady²,

Hornberger³

et al. 2014

Circulation

1,020

543

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Background— The goal of this statement is to review available literature and to put forth a scientific statement on the current practice of fetal cardiac medicine, including the diagnosis and management of fetal cardiovascular disease. Methods and Results— A writing group appointed by the American Heart Association reviewed the available literature pertaining to topics relevant to fetal cardiac medicine, including the diagnosis of congenital heart disease and arrhythmias, assessment of cardiac function and the cardiovascular system, and available treatment options. The American College of Cardiology/American Heart Association classification of recommendations and level of evidence for practice guidelines were applied to the current practice of fetal cardiac medicine. Recommendations relating to the specifics of fetal diagnosis, including the timing of referral for study, indications for referral, and experience suggested for performance and interpretation of studies, are presented. The components of a fetal echocardiogram are described in detail, including descriptions of the assessment of cardiac anatomy, cardiac function, and rhythm. Complementary modalities for fetal cardiac assessment are reviewed, including the use of advanced ultrasound techniques, fetal magnetic resonance imaging, and fetal magnetocardiography and electrocardiography for rhythm assessment. Models for parental counseling and a discussion of parental stress and depression assessments are reviewed. Available fetal therapies, including medical management for arrhythmias or heart failure and closed or open intervention for diseases affecting the cardiovascular system such as twin–twin transfusion syndrome, lung masses, and vascular tumors, are highlighted. Catheter-based intervention strategies to prevent the progression of disease in utero are also discussed. Recommendations for delivery planning strategies for fetuses with congenital heart disease including models based on classification of disease severity and delivery room treatment will be highlighted. Outcome assessment is reviewed to show the benefit of prenatal diagnosis and management as they affect outcome for babies with congenital heart disease. Conclusions— Fetal cardiac medicine has evolved considerably over the past 2 decades, predominantly in response to advances in imaging technology and innovations in therapies. The diagnosis of cardiac disease in the fetus is mostly made with ultrasound; however, new technologies, including 3- and 4-dimensional echocardiography, magnetic resonance imaging, and fetal electrocardiography and magnetocardiography, are available. Medical and interventional treatments for select diseases and strategies for delivery room care enable stabilization of high-risk fetuses and contribute to improved outcomes. This statement highlights what is currently known and recommended on the basis of evidence and experience in the rapidly advancing and highly specialized field of fetal cardiac care.

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Section: Impact On Survivalmentioning

confidence: 99%

“…In a study of fetuses with heart failure, heart function improved as measured by the CVP score in a small group of fetuses treated with digoxin. 465,466 A dose of 0.25 mg orally twice a day was used with no maternal complications.…”

Section: Medical Therapy For Fetal Congestive Heart Failurementioning

confidence: 99%

Diagnosis and Treatment of Fetal Cardiac Disease

Donofrio¹,

Moon-Grady²,

Hornberger³

et al. 2014

Circulation

1,020

543

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“…Preliminary information suggests that digoxin may be useful in improving the cardiovascular profile score in fetuses with signs of CHF. 29 At this time, we use digoxin for fetal cardiac failure due to arrhythmias and high output states, such as fistula and anemia, when the cardiovascular profile score is 7 or less. Laser treatment of the twin-twin communications or cord ligation with acardiac twins can be applied to improve cardiac failure.…”

Section: Treatment For Fetal Chfmentioning

confidence: 99%

Doppler in Fetal Heart Failure

Huhta¹,

Paul

2010

Clinical Obstetrics &Amp; Gynecology

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Fetal echocardiography has progressed to be able to diagnose many forms of congenital heart disease (CHD) and to assess the prognosis of cardiac lesions based on their anatomy and presentation in utero. Fetal echocardiography is for pregnancies at risk of structural, functional, and rhythm-related fetal heart disease. Routine obstetrical ultrasound screening is critical in the prenatal detection of fetal heart disease/CHD. With or without CHD, fetal heart dysfunction defined as inadequate tissue perfusion may occur. Perinatal problems other than CHD can also be assessed, such as the effects of noncardiac malformations that affect hemodynamics, that is, twin-twin transfusion. Cardiac rhythm can affect cardiac function and outcome, and prenatal diagnosis can be lifesaving. A tool for the assessment of cardiac function is the Cardiovascular Profile Score that combines ultrasonic markers of fetal cardiovascular unwellness based on univariate parameters, which have been correlated with perinatal mortality. This "heart failure score" could potentially be used in much the same way as and in combination with the biophysical profile score. This study will present a summary of fetal Doppler and its place in the diagnosis and assessment of prognosis of fetal heart failure.

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“…24,33 These are uncommon conditions, with published reports limited to individual cases, 24,33 so the efficacy of digoxin in their management is unknown.…”

Section: Fetal Hydrops Due To Other Cardiac Causesmentioning

confidence: 99%