Objective Study the clinical efficacy and safety of transplacental digoxin therapy for foetal heart failure. Investigate the evaluation and treatment guiding value of cardiovascular profile score (CVPS) and myocardial performance index (Tei index) on foetal heart failure.
Methods According to the research protocol, with written informed consent, foetal heart failure cases, diagnosed in West China Second University Hospital of Sichuan University during May 2008 to December 2011, were enrolled in this case-control study. According to the prospective parent’s opinions, the included subjects were divided into digoxin treatment group (Dig group) and control group (Con group). To Dig group, transplacental digoxin therapy was preformed; whileas the Con group only received short-term clinical observation. During the clinical course, foetal CVPS and ventricular Tei index were dynamic monitored, pregnant outcomes were observed and recorded. A number of healthy pregnant women and foetuses were enrolled as normal control group, who were registered in West Chinasecond university hospital for their routine antenatal care, the foetal CVPS and right ventricular Tei index were dynamic measured and recorded at the time points of 20, 24, 28, 32, 36 gestational weeks and just before delivery.
Results ➀ Ten cases of foetal heart failure were enrolled in Dig group, including 4 cases of foetal atrial flutter (AF), 3 cases of foetal supraventricular tachycardia (SVT), 2 cases of foetal anaemia (MA) and 1 case of foetal dilated cardiomyopathy (DCM). After a consultation the individual protocol of transplacental digoxin therapy was determined. Fetal heart failure was gradually controlled in AF, SVT and MA foetuses with transplacental digoxin therapy. These cases achieved uneventful post-therapy pregnancy and full-term delivery. CVPS increased gradually, at or near the 10 points, left and right ventricular Tei index decreased gradually, closed to normal range. 10 to 55 months follow-ups have been finished, evaluation from Bayley Scale of Infant Development (BSID) revealed the normal growth and development of physique and mentality in all the enrolled children. ➁ Nine cases of foetal heart failure cases were enrolled in Con group, including 4 AF, 3 SVT and 2 MA. Among these cases, 1 case of SVT and 1 case of AF were observed spontaneously converting to sinus rhythm for 5 days and 7 days observation respectively, and then they were transferred into digoxin group and received transplacental digoxin therapy. The other cases manifested as gradually decreased CVPS and increased Tei index, and had pregnancy termination finally after short-term clinical observation. 30 healthy pregnant women and their healthy foetuses were incorporated into the normal control group. And CVPS of all foetuses at each time points were all 10 points. With the gestational age progression, foetal right ventricular Tei index decreased gradually, the value is 0.48 ± 0.05 at 20 GW and decreased to 0.38 ± 0.04 before delivery.
Conclusions Digoxin is list in the first line medicaments and has important clinical value in clinical treatment for foetal heart failure. With the alleviating of foetal heart failure, CVPS increases gradually, and ventricular Tei index decreases, negative correlation is showed between the two parameters. CVPS and Tei index can effectively guide the prenatal transplacental digoxin therapy for foetal heart failure. Timely and effective prenatal intervention can significantly improve the prognosis of the suffered foetuses.