Hospital Central Universitario “Antonio María Pineda”; Barquisimeto – Estado Lara, Venezuela.

Case report

A 24-year-old patient was referred to our unit at 27 weeks of pregnancy because of a polyhydramnios. Our ultrasound evaluation showed the followings findings:

• Severe dilatation of the left atrium and left ventricle of the heart with a thickened, echogenic, and poorly contractible wall of the left ventricle (endocardial fibroelastosis);

• The mitral valve was insufficient (demonstrated by the color and pulsed Doppler) and a very little blood flow entering the left ventricle was seen during the diastole;

• The aortic valve was thickened and echogenic and a reverse flow in the aortic arch was demonstrated using color and pulsed Doppler. The Doppler trace of the image 6 shows anterograde flow which correspond to the blood flow in the pulmonary artery and a retrograde blood flow in the aortic arch. This demonstrates the anomaly is a ductus arteriosus dependent cardiopathy.

The final diagnosis was critical aortic stenosis.

Images 1, 2: The images show a mitral valve insufficiency demonstrating by the color (image 1) and pulsed (image 2) Dopplers.

Images 3, 4: The images show reversed flow across the mitral valve.

Images 5: The Doppler tracing at the image 6 shows the anterograde and retrograde blood flows in the aortic arch. 

Video 1: The video shows transverse scans of the fetal thorax showing a four-chamber view of the heart with the dilatation of the left atrium and ventricle. At the level of the mitral valve there is regurgitation visible. Second part of the video shows the left and right outflow tracts of the heart with a marked stenosis of the aorta. The third part of the video shows a three-vessel view of the heart with the reversed flow in the aorta.