ATRIOVENTRICULAR VALVE INSUFFICIENCY ASSOCIATED WITH CONGENITAL HEART DISEASE DETECTED IN UTERO USING COMBINED 2D ECHO/DOPPLER ULTRASOUND

Abstract

Little is known about the effects of atrioventricular valve insufficiency (AVVI) in utero in association with congenital heart disease. Using an ATL ultrasound system with a 3 MHz range-gated pulsed Doppler (PD) transducer we found 3 of 114 fetuses had AVVI. The atria were insonated using the 2D echocardiographic image as a guide for position. The mother of one fetus, gestational age (GA) of 20 weeks, had received high dosage lithium during early pregnancy. Tricuspid insufficiency was associated with Ebstein's anomaly of the tricuspid valve. Serial studies showed nonimmune fetal hydrops (NIH) developed at 34 weeks GA. Labor was induced but the fetus died from low cardiac output and blood pressure after delivery. At postmortem the diagnosis was confirmed. A second fetus, 36 weeks GA, was referred for examination because of bradycardia. The 2D echocardiogram showed an atrioventricular canal defect. NIH was present. PD showed insufficiency of the common atrioventricular valve. Following induction of labor and delivery, low cardiac output and blood pressure persisted despite medication and the infant died. In a 23 week twin pregnancy, one fetus had NIH. 2D echo showed this fetus to have pulmonary atresia with a normally developed right ventricle. Tricuspid insufficiency was found by PD. The pregnancy terminated spontaneously. AVVI in the presence of congenital heart disease has a poor prognosis. Associated NIH may make the prognosis even worse and reflect in utero cardiac failure.