Department of Gynecology, Félix Guyon Hospital, 97400 Saint-Denis, Ile de la Réunion, France.

Case report:

This is a 32-year-old woman (G2P1) who was referred to our antenatal unit at 34 weeks for a routine examination. There was no family history of congenital disease. The patient did not take any medication.

In our antenatal unit, we noticed normal fetal morphology except for the heart.

Echocardiography showed:

• Abnormal pulmonary artery enlargement without atrial or ventricular hypertrophy 
• The aortic and atrial-ventricular valves were normal. 
• Ebstein anomaly was absent.
• Abnormal post-valvular dilatation. Doppler analysis showed flow acceleration.

After extensive counseling, the patient accepted to perform amniocentesis and another sonography. Fetal karyotype was normal. Williams and Di-George deletion were absent.

The patient delivered at 39 weeks. The baby had a normal post-natal adaptation without cyanosis. Echocardiography confirmed the diagnosis.

The final diagnosis was moderate pulmonary valvular stenosis with intact septum.

Figure 1: 3D sonography view of the fetus face.

Figure 2: 2D view of the three vessels, showing different diameter between aorta and pulmonary artery.

Figure 3, 4: 2D view of the two great vessels at 35 weeks, showing normal aorta Doppler; post-valvular pulmonary artery dilatation and its two branches.

Figure  5, 6: 2D views of the pulmonary artery and the two branch. We can see normal right and left pulmonary artery diameter (1 and 2) with post-valvular pulmonary dilatation (asterisk)

Figure 7, 8: At 35 weeks, Doppler scan: we can observe post-valvular dilatation, with abnormal doppler waveform (V > 100 cm/s).

Figure 9, 10:  2D views of the pulmonary artery (2) at 37 weeks, showing the significant difference in dimension to aorta (1). We can see pulmonary valve stenosis (3-5 mm),

Video clip 1: Video clip showed two great vessels and the discordance in dimension between them. 

Video 2: The pulmonary valve stenosis with the post-valvular dilatation.