Parinatology Unit, Villavicencio, Meta, Colombia.

Case report

A 24-year-old woman (G2P1), with a non-contributive family history was referred to our unit at 33 weeks due to a fetal cardiomegaly. Our examination showed:

• A fetal heart enlargement with global dilation of the ventricles and atria, with predominant enlargement of the left parts of the heart, mainly of the left atrium;
• Marked mitral regurgitation;
• Retrograde blood flow within the aortic arch.

The findings were suggestive of aortic atresia. An elective Cesarean section was done at 38 weeks and the newborn showed poor neonatal adaptation with signs of the cardiac insufficiency. The postnatal ultrasound found severe dilated cardiomyopathy with poor contractions of the left ventricle, but without aortic atresia, stenosis or coarctation. The cardiomyopathy had probably diminished the left ventricular systolic function, causing a "functional aortic atresia" without anatomic atresia.  TORCH infections were excluded. The neonate died the next day after delivery, but no other examinations were performed.

Images 1, 2: The images show four-chamber view of the heart with marked dilatation of the chambers, predominantly of the left atrium.

Images 3, 4, 5, and 6: Color Doppler images showing the four-chamber view of the enlarged heart with marked mitral regurgitation.

Images 7, 8: The images show gray-scale (Image 7) and color Doppler (Image 8) scans of the heart at the level of the three-vessel view. The color Doppler image shows opposite directions within the pulmonary artery and aorta suggestive of aortic atresia. This phenomenon was actually caused by diminished left ventricular function due to the dilated cardiomyopathy.

Images 9, 10: The images show fetal aortic arch. Color Doppler shows that the direction of the blood flow goes out of the transducer, towards the heart. This indicate that the aortic arch is filled with the blood going from the pulmonary artery through the ductus arteriosus, which was suggestive of aortic atresia. The postnatal ultrasound showed the phenomenon was actually caused by diminished left ventricular function due to the dilated cardiomyopathy, causing a "functional aortic atresia".

Videos 1, 2: The video show four-chamber view of the heart. The video 1 shows marked dilatation of the left atrium and left ventricle. The video 2 shows bidirectional flow at the level of the foramen ovale.