Pulmonary Valvar Stenosis from the Fetal to the Infantile Period: A Case Report

Document Type : Case Report

Authors

1 Department of Pediatrics, School of Medicine, Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

2 Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

3 Men's Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran

4 Shahid Beheshti University of Medical Sciences

5 Department of Pediatrics, School of Medicine, Kashan University of Medical Sciences and Health Services, Kashan, Iran

6 Department of Pediatrics, Kermanshah University of Medical Sciences, Kermanshah, Iran

Abstract

Background: Fetal echocardiography is a useful tool for diagnosing fetuses with congenital heart diseases, and it is best to be conducted between 17 and 19 weeks of gestational age. However, fetal echocardiography can be performed at other ages of pregnancy for a variety of reasons. This study describes one fetus with pulmonary valvar stenosis based on the fetal echocardiogram in the uterus.
Case report: This study describes one fetus with pulmonary valve stenosis based on the fetal echocardiogram in the uterus. We referred the family to a hospital with neonatal intensive care unit admission. After birth, we followed her serially and confirmed pulmonary valve stenosis, which increased in severity after two months. Subsequently, we performed a percutaneous balloon valvuloplasty.
Conclusion: Our findings showed that some cardiac defects could vary in severity during pregnancy and post-birth. There was clear evidence that pulmonary valvar stenosis was a lesion developed during the fetus's lifetime to tolerate the lesion. Although pulmonary stenosis progressed in the early months after birth, it was easily treated through balloon angioplasty.
 
 

Keywords


  1. Bravo-Valenzuela NJ, Peixoto AB, Araujo Júnior E. Prenatal diagnosis of congenital heart disease: A review of current knowledge. Indian Heart J. 2018;70(1):150-64.
  2. Straub L, Huybrechts KF, Bateman BT, Mogun H, Gray KJ, Holmes LB, et al. The Impact of Technology on the Diagnosis of Congenital Malformations. Am J Epidemiol. 2019;188(11):1892-901.
  3. Liu L, Wang H, Cui C, Li Y, Liu Y, Wang Y, et al. Prenatal echocardiographic classification and prognostic evaluation strategy in fetal pulmonary atresia with intact ventricular septum. Medicine. 2019;98(42):e17492.
  4. Edwards LA, Justino H, Morris SA, Rychik J, Feudtner C, Lantos JD. Controversy About a High-Risk and Innovative Fetal Cardiac Intervention. Pediatrics. 2018;142(3):e20173595.
  5. Latson LA. Critical pulmonary stenosis. J Interv Cardiol. 2001;14(3):345-50.
  6. Yamamoto Y, Hornberger LK. Progression of outflow tract obstruction in the fetus. Early Hum Dev. 2012;88(5):279-85.
  7. Gottschalk I, Strizek B, Menzel T, Herberg U, Breuer J, Brockmeier K, et al. Severe Pulmonary Stenosis or Atresia with Intact Ventricular Septum in the Fetus: The Natural History. Fetal Diagn Ther. 2020;
    47(5):420-428.
  8. Masura J, Burch M, Deanfield JE, Sullivan ID. Five-year follow-up after balloon pulmonary valvuloplasty. J Am Coll Cardiol. 1993;21(1):132-6.
  9. Elzenga NJ, Gittenberger-de Groot AC. The ductus arteriosus and stenoses of the pulmonary arteries in pulmonary atresia.Int J Cardiol. 1986;11(2):195-208.
  10. Arlettaz R, Archer N, Wilkinson AR. Closure of the ductus arteriosus and development of pulmonary branch stenosis in babies of less than 32 weeks gestationArch. Dis. Child. Fetal Neonatal Ed. 2001;85(3):F197-200.
  11. Wang JK, Wu MH, Lee WL, Cheng CF, Lue HC. Balloon dilatation for critical pulmonary stenosis. Int J Cardiol. 1999;69(1):27-32.
  12. Khalil M, Jux C, Rueblinger L, Behrje J, Esmaeili A, Schranz D, et al. Acute therapy of newborns with critical congenital heart disease. Transl Pediatr. 2019;8(2):114-26.
  13. Bronshtein M, Blumenfeld Z, Khoury A, Gover A. Diverse outcome following early prenatal diagnosis of pulmonary stenosis. Ultrasound Obstet Gynecol. 2017;49(2):213-8.
  14. Zucker EJ. Cross-sectional imaging of congenital pulmonary artery anomalies. The Int J Card Imaging. 2019;35(8):1535-48.