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1.
J Obstet Gynaecol Res ; 41(7): 1137-40, 2015 Jul.
Article in English | MEDLINE | ID: mdl-25772579

ABSTRACT

We describe a rare case of fetal critical aortic stenosis with spontaneous relief of severe restrictive atrial communication, resulting in complete resolution of hydrops fetalis in utero. Fetal ultrasonography showed hydrops fetalis caused by critical aortic stenosis with a severely restrictive foramen ovale and severe mitral regurgitation at 23 weeks of gestation. Hydrops fetalis, however, spontaneously resolved, showing an obvious increase of flow through the foramen ovale and pulmonary vein at 26 weeks of gestation. The neonate required balloon dilation of the aortic valve and balloon atrioseptostomy immediately after birth and also received bilateral pulmonary artery banding and arterial duct stenting 1 week later. The patient was in good condition after conversion to biventricular circulation via Ross procedure at 8 months old. The present case suggests that atrioseptostomy as a fetal intervention may improve outcome in even a hydropic condition.


Subject(s)
Abnormalities, Multiple/embryology , Aortic Valve Stenosis/embryology , Cardiomyopathy, Restrictive/embryology , Foramen Ovale/abnormalities , Heart Septal Defects, Atrial/embryology , Hydrops Fetalis/physiopathology , Mitral Valve Insufficiency/embryology , Abnormalities, Multiple/diagnostic imaging , Abnormalities, Multiple/surgery , Adolescent , Aortic Valve Stenosis/diagnostic imaging , Aortic Valve Stenosis/surgery , Cardiomyopathy, Restrictive/diagnostic imaging , Cardiomyopathy, Restrictive/surgery , Echocardiography, Doppler, Color , Female , Foramen Ovale/diagnostic imaging , Foramen Ovale/embryology , Foramen Ovale/surgery , Heart Septal Defects, Atrial/diagnostic imaging , Heart Septal Defects, Atrial/surgery , Humans , Hydrops Fetalis/diagnostic imaging , Infant, Newborn , Japan , Mitral Valve Insufficiency/diagnostic imaging , Mitral Valve Insufficiency/surgery , Pregnancy , Pregnancy Trimester, Second , Remission, Spontaneous , Severity of Illness Index , Term Birth , Treatment Outcome , Ultrasonography, Prenatal
2.
Ginecol Obstet Mex ; 82(9): 627-33, 2014 Sep.
Article in Spanish | MEDLINE | ID: mdl-25412557

ABSTRACT

This is a report about a case of prenatal diagnosis of critical fetal aortic stenosis with severe mitral valve insufficiency in a 35+6 weeks fetus. Aortic stenosis represents 3% of congenital heart diseases, but its association with mitral regurgitation is quite unusual. Thanks to the latest advances in fetal ultrasonography we can now achieve a more precise diagnosis and we have been able to improve the understanding of its physiopathology. Based on this case we have reviewed the most recent literature about fetal aortic stenosis and mitral valve insufficiency, with the aim of summarizing its main physiopathological features, highlighting the clues and key points for its intrauterine diagnosis, describing its principal complications and summarizing its current treatment options.


Subject(s)
Aortic Valve Stenosis/embryology , Fetal Heart/diagnostic imaging , Mitral Valve Insufficiency/embryology , Ultrasonography, Prenatal/methods , Adult , Aortic Valve Stenosis/complications , Aortic Valve Stenosis/diagnostic imaging , Aortic Valve Stenosis/physiopathology , Aortic Valve Stenosis/surgery , Cardiac Catheterization , Cesarean Section , Echocardiography, Doppler, Color , Echocardiography, Doppler, Pulsed , Endocardial Fibroelastosis/diagnostic imaging , Endocardial Fibroelastosis/embryology , Endocardial Fibroelastosis/surgery , Female , Gestational Age , Heart Transplantation , Humans , Infant, Newborn , Male , Mitral Valve Insufficiency/diagnostic imaging , Mitral Valve Insufficiency/etiology , Mitral Valve Insufficiency/surgery , Polyhydramnios , Pregnancy , Prognosis , Reoperation , Stents , Ventricular Dysfunction, Left/etiology
4.
Pediatr Cardiol ; 34(8): 1797-802, 2013.
Article in English | MEDLINE | ID: mdl-23666083

ABSTRACT

Atrioventricular valve regurgitation (AVVR) is a clinically important element of the common atrioventricular canal defect. Cardiac preload and afterload increase from prenatal to postnatal life. These hemodynamic changes may increase the degree of regurgitation and affect management and prognosis. We sought to investigate the frequency of change in degree of AVVR from fetal to postnatal life in this patient population. Subjects who underwent both fetal and postnatal echocardiography within 4 weeks of life between January 2008 and September 2010 were included in the study. Degree of AVVR was assessed by color Doppler imaging and scored as 0 (no regurgitation), 1 (hemodynamically insignificant regurgitation), and 2 (hemodynamically important regurgitation). Forty-nine subjects were included. Mean gestational age at fetal echocardiogram was 34 ± 2.8 weeks; age at postnatal echocardiogram was a median of <24 h of age (range 0-24). After birth, 69 % subjects had no change, 8 % of subjects had a decrease, and 22 % subjects had an increase in AVVR grade. Five patients progressed from a fetal score 0 or 1 to postnatal score 2. Neither trisomy 21 nor heterotaxy syndrome were risk factors for progression of AVVR. In patients with AV canal defects, 90 % demonstrate no hemodynamically significant change in AVVR from fetal to postnatal life, whereas 10 % display a hemodynamically significant change. AVVR appreciated in utero is predictive of neonatal regurgitation in the majority of patients. These findings have implications for the counseling and management of the fetus with AV canal defect.


Subject(s)
Echocardiography, Doppler, Color/methods , Endocardial Cushion Defects/complications , Fetal Heart/diagnostic imaging , Mitral Valve Insufficiency/etiology , Ultrasonography, Prenatal , Disease Progression , Endocardial Cushion Defects/diagnosis , Endocardial Cushion Defects/embryology , Female , Fetal Heart/embryology , Follow-Up Studies , Gestational Age , Heart Septal Defects , Humans , Infant, Newborn , Mitral Valve Insufficiency/diagnosis , Mitral Valve Insufficiency/embryology , Pregnancy , Prognosis , Retrospective Studies
5.
Arch Cardiovasc Dis ; 104(8-9): 465-79, 2011 Aug.
Article in English | MEDLINE | ID: mdl-21944149

ABSTRACT

Congenital malformations of the mitral valve may be encountered in isolation or in association with other congenital heart defects. Each level of the mitral valve complex may be affected, according to the embryological development, explaining the fact that these lesions are sometimes associated with each other. As a perfect preoperative assessment is of importance, good knowledge of both normal and abnormal anatomy is required in order to guide the surgeon accurately. This review presents the different embryological, anatomical and echocardiographic aspects of the congenital mitral anomalies.


Subject(s)
Heart Defects, Congenital , Mitral Valve Insufficiency/congenital , Mitral Valve Stenosis/congenital , Mitral Valve/abnormalities , Papillary Muscles/abnormalities , Cardiac Surgical Procedures , Echocardiography, Doppler, Color , Echocardiography, Three-Dimensional , Heart Defects, Congenital/diagnosis , Heart Defects, Congenital/embryology , Heart Defects, Congenital/surgery , Humans , Mitral Valve/diagnostic imaging , Mitral Valve/surgery , Mitral Valve Insufficiency/diagnosis , Mitral Valve Insufficiency/embryology , Mitral Valve Insufficiency/surgery , Mitral Valve Stenosis/diagnosis , Mitral Valve Stenosis/embryology , Mitral Valve Stenosis/surgery , Papillary Muscles/diagnostic imaging , Papillary Muscles/surgery , Predictive Value of Tests , Treatment Outcome
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