Critical pulmonary stenosis with intact ventricular septum and fetal arrhythmias.
A 23-year-old woman, gravida 1, was referred to our hospital for possible fetal distress at 32 weeks of pregnancy. A fetal cardiotochogram showed a reactive pattern, but mild continuous bradycardia and an intermittent pulse were observed, regarded as a sinus type and a type of A-V block, respectively. The continuous deceleration of the heart rate to 95 bpm was observed frequently at 35 weeks, 3 days of gestation. Thus, an emergent cesarean section was performed and a viable 2,082 g female infant was delivered. The neonate gradually became cyanotic, and an echocardiogram was performed. The neonate was regarded as a right ventricular outflow obstruction with intact ventricular septum. Unlike other cases, the infant revealed a moderately developed right ventricle despite a severely stenotic tricuspid valve. The infant died 27 days after birth and an autopsy established the diagnosis of critical pulmonary stenosis with intact ventricular septum. Right ventricular myocardial sinusoidal-coronary artery connections, one of the major features of this type of heart anomaly, was speculated to be involved in the cause of fetal bradyarrhythmias.
Kuwabara
Yoshimitsu
Y
Department of Obstetrics and Gynecology, Japanese Red Cross Katsushika Maternity Hospital, Tokyo, Japan. kuwa@nms.ac.jp
Shima
Yoshio
Y
Takeuchi
Masato
M
Shinohara
Tsuguo
T
Awataguchi
Kouichi
K
Araki
Tsutomu
T
Shin
Sumio
S
D000328:Adult; D001919:Bradycardia / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D002585:Cesarean Section; D003937:Diagnosis, Differential; D004452:Echocardiography; D017809:Fatal Outcome; D005260:Female; D005316:Fetal Distress / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D005333:Fetus / Q000098:blood supply; D006346:Heart Septum / Q000000981:diagnostic imaging; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D011263:Pregnancy Trimester, Third; D011296:Prenatal Diagnosis; D011666:Pulmonary Valve Stenosis / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D014682:Vena Cava, Inferior / Q000502:physiology