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2012-08-24-11 Aortic valve stenosis, endocardial fibroelastosis © Fabrice Cuillier www.thefetus.net

Aortic valve stenosis with endocardial fibroelastosis


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

Case report: 

This 28-year-old woman (G2P1) was referred to our antenatal unit at 24 weeks for a fetal cardiopathy. There was no known family history of congenital disease. The patient did not take any medication.   
In our antenatal unit, the ultrasound demonstrated the following features in the fetal heart:  
  • A four-chamber view shows that the right ventricle is larger than the left ventricle, with thickened, hyperechoic and severely hypokinetic walls (Fig.1, 2).
  • Color Doppler of the aorta was abnormal with increased flow velocity (Fig. 5).
  • Aortic valve stenosis was present. 
  • Color Doppler of pulmonary artery seemed normal, with normal flow (Fig. 6). 
An amniocentesis was proposed (Normal karyotype). 
At 27 weeks, this cardiopathy was confirmed (Fig. 9, 10). Color Doppler images showed aortic arch with coarctation. We also noticed the increased flow velocity at the narrowed aorta valve. 
The parents were informed about the surgical perspective and the fetal prognosis. They decided to continue the pregnancy, without fetal surgery. The delivery happened at 37 weeks. The cardiopathy was confirmed. When Prostine was stopped, the baby died at day 10. 

Figure 1, 2: A four-chamber view shows the right ventricle larger than the left ventricle, with thickened, hyperechoic and severely hypokinetic walls.

 

Figure 3, 4: Two outflow tract at 24 weeks



Figure 5: 24 weeks; Color Doppler of the aorta was abnormal with increased flow velocity



Figure 6: 24 weeks; Color Doppler pulmonary artery seemed normal, with normal flow 




Figure 7, 8: 27 weeks; Four chamber view with abnormal dimensions of both ventricles




Figure 9, 10: Two outflow tract view at 27 weeks



 
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