1/31. Transplacental flecainide therapy for fetal supraventricular tachycardia in a twin pregnancy.We present the case of a twin pregnancy in which 1 fetus developed hydrops secondary to supraventricular tachycardia at 30 weeks' gestation. Transplacental flecainide administration successfully treated the condition without evidence of maternal or fetal side-effects. The case raises ethical and possibly legal issues that present when 1 fetus in a twin pregnancy develops a condition the management of which could cause complications to the other twin and/or the mother.- - - - - - - - - - ranking = 1keywords = hydrops (Clic here for more details about this article) |
2/31. Neurological morbidity after fetal supraventricular tachyarrhythmia.BACKGROUND: Fetal tachyarrhythmia is a well-documented entity which, in the absence of pharmacological intervention, may lead to congestive heart failure, fetal hydrops and eventually fetal demise. The success rate of the implemented treatment is generally measured by survival and achievement of control of the arrhythmia. We report on the occurrence of associated cerebral damage in three patients with fetal tachycardia. methods: We describe three patients with a history of fetal supraventricular tachyarrhythmia who developed cerebral complications in utero. RESULTS: Two patients had cerebral hypoxic-ischemic lesions and one had hemorrhagic lesions present at birth. They had developed severe congestive heart failure and fetal hydrops secondary to fetal tachyarrhythmia, and there were no other obvious causes for the cerebral pathology. Two of these patients were referred to us antenatally. Therapy was instituted and resulted in control of the tachycardia and resolution of hydrops. The third patient was referred to our clinic shortly after birth because of severe circulatory problems secondary to fetal tachyarrhythmia. CONCLUSION: From these observations, we believe that a fetus with tachyarrhythmia and subsequent hydrops is at increased risk for the development of cerebral complications, due to the circulatory disturbances and sudden changes in heart rate which may lead to fluctuations in cerebral perfusion. This would imply that it is of the utmost importance to aim at immediate and complete control of the heart rate in the treatment of fetal tachyarrhythmia.- - - - - - - - - - ranking = 4keywords = hydrops (Clic here for more details about this article) |
3/31. Fetal tachydysrhythmia associated with nonimmune hydrops.A case of fetal tachydysrhythmia with intermittent episodes of bradycardia associated with severe nonimmune hydrops was detected at 36 weeks of pregnancy. Paroxysms of supraventricular tachycardia were documented postnatally. Induction of labor and postnatal administration of digoxin showed to be a rational therapeutic approach in this case. In spite of some unfavorable clinical predictors the treatment resulted in a benign course of the disease.- - - - - - - - - - ranking = 5keywords = hydrops (Clic here for more details about this article) |
4/31. Radiofrequency catheter ablation in a haemodynamically compromised premature neonate with hydrops fetalis.A preterm infant was born at 35 weeks gestation after failed antenatal antiarrhythmic therapy. The infant had an incessant supraventricular tachycardia, impaired ventricular function and hypotension and failed to respond to adenosine, cardioversion and intravenous amiodarone. After resuscitation from cardiovascular collapse, a successful radiofrequency catheter ablation (RFA) of a left free wall atrioventricular pathway was performed at 24 h of age without extracorporeal support. The infant is normal on follow up at 12 months of age. Whilst most fetal and neonatal supraventricular tachyarrhythmias respond to antiarrhythmic medications and RFA is not required, this is the earliest RFA to be performed on a premature infant when antiarrhythmics have failed.- - - - - - - - - - ranking = 4keywords = hydrops (Clic here for more details about this article) |
5/31. Successful treatment of refractory supraventricular tachycardia by repeat intravascular injection of amiodarone in a fetus with hydrops.We report the case of a fetus with supraventricular tachycardia complicated by congestive heart failure and ascites. After failure of initial transplacental treatment, the injection of amiodarone into the umbilical vein combined with evacuation of ascites achieved conversion to sinus rhythm and restored cardiac function thus allowing pregnancy to go to term. This report suggests that direct fetal therapy by umbilical vein puncture and evacuation of effusions constitutes an effective treatment for supraventricular tachycardias with massive fetal hydrops which do not respond to transplacental treatment.- - - - - - - - - - ranking = 5keywords = hydrops (Clic here for more details about this article) |
6/31. adenosine triphosphate for cardioversion of supraventricular tachycardia in two hydropic fetuses.OBJECTIVE: We performed a retrospective study to check the effectiveness of adenosine triphosphate (Striadyne) for cardioversion of fetal supraventricular tachycardia (SVT) and to evaluate neonatal outcome after prenatal treatment of severe SVT with fetal hydrops. methods: Two hydropic fetuses with SVT were treated with Striadyne injection into the umbilical vein, as an additional treatment to the digoxin given intravenously to the mother. Both fetuses were in severe condition, with ultrasound, Doppler and laboratory signs of fetal distress and congestive heart failure. RESULTS: Sinus rhythm was obtained in both cases for different periods of time, without side effects of Striadyne. The children survived. There were severe cardiac and neurologic problems after delivery. CONCLUSIONS: Striadyne was an effective drug in converting SVT to the sinus rhythm in hydropic fetuses. digoxin was useless in these fetuses in spite of the therapeutic level which was obtained in both mothers. We suppose that fetal SVT causing fetal hydrops could be the reason of brain damage, and intensive antiarrhythmic treatment seemed to be necessary.- - - - - - - - - - ranking = 2keywords = hydrops (Clic here for more details about this article) |
7/31. Supraventricular tachycardia with hydrops in a 27-week premature baby.A 27-week baby with antenatally diagnosed supraventricular tachycardia (SVT) and hydrops fetalis was delivered by emergency caesarean section because of severe fetal bradycardia. The mother was on flecanide to control the fetal SVT. The baby was hydropic at birth and required prolonged ventilatory support. On day 6, he developed acute renal failure for which peritoneal dialysis was done. On day 23, he developed several episodes of supraventricular tachycardia (SVT) which did not respond to intravenous adenosine and amiodarone and ultimately required intravenous flecanide. This case report highlights the management of a critically ill premature hydropic baby with resistant SVT, and the successful outcome.- - - - - - - - - - ranking = 5keywords = hydrops (Clic here for more details about this article) |
8/31. Successful digoxin therapy of fetal supraventricular tachycardia in a triplet pregnancy.BACKGROUND: Fetal supraventricular tachycardia is a rare complication of pregnancy associated with cardiac failure, hydrops, and fetal death. If no underlying cardiac defects are present, medical management with digoxin has been successful. CASE: A young woman with a triplet pregnancy presented at 23 17 weeks' gestation for routine Doppler auscultation which suggested fetal supraventricular tachycardia, confirmed by M-mode echocardiography. She was treated with oral digoxin for the remainder of her pregnancy with subsequent conversion of the tachycardic triplet to normal sinus rhythm with occasional premature atrial beats. After delivery, the triplet previously demonstrating supraventricular tachycardia had a normal sinus rhythm. CONCLUSION: digoxin might be used safely and successfully to treat fetal supraventricular tachycardia in multifetal pregnancies.- - - - - - - - - - ranking = 1keywords = hydrops (Clic here for more details about this article) |
9/31. Successful treatment of supraventricular tachycardia exhibiting hydrops fetalis with flecainide acetate. A case report.BACKGROUND: The efficacy of flecainide acetate for the treatment of fetal supraventricular tachycardia with hydrops fetalis and changes in venous blood flow patterns in the fetus during treatment are reported. CASE: Oral flecainide administration was started at 30 weeks of gestation. Cardioversion was achieved 6 days after treatment. Sustained abnormal venous Doppler indices were shown and complete normalization of venous returns was observed 6 days after cardioversion. A vigorous male baby was born, and he is now 1 year of age and in good condition with no medication. CONCLUSION: Reversible cardiac dysfunction was observed even after cardioversion in the fetus with supraventricular tachycardia, which could be assessed precisely by venous Doppler analysis.- - - - - - - - - - ranking = 5keywords = hydrops (Clic here for more details about this article) |
10/31. Fetal supraventricular tachycardia diagnosed and treated at 13 weeks of gestation: a case report.Supraventricular tachycardia (SVT) is the most commonly encountered clinically significant tachycardia in the fetus. When SVT is sustained, congestive heart failure and fetal hydrops may ensue, due to both systolic and diastolic dysfunction. Sonographic diagnosis is usually incidental during the second or third trimester. Treatment goals are cardioversion to sinus rhythm and reversal of cardiac dysfunction. We describe a case of fetal SVT diagnosed at 13 weeks of gestation. Treatment with digoxin and flecainide was successful; the heart rate returned to sinus rhythm within one day, and fetal hydrops resolved within 8 days of treatment. We suspect that as more first-trimester examinations are performed, more cases with SVT will be diagnosed. We discuss the treatment protocol, and suggest that co-administration of two drugs that act synergistically may be more efficient than monotherapy, which is currently used as the first line of treatment. In addition, we discuss the potentially deleterious effect of heart failure encountered at an early developmental stage on the central nervous system. More data need to be collected in order to substantiate a clear recommendation regarding optimal management.- - - - - - - - - - ranking = 2keywords = hydrops (Clic here for more details about this article) |
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