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2015-05-09-08 Supraventricular tachycardia – pre-terminal recording of hemodynamics by STIC © Badr www.TheFetus.net 


A case of supraventricular tachycardia – pre-terminal recording of hemodynamics by STIC

Islam Badr, M.Sc.1; Sameh Abdel Latif Abdel Salam, M.Sc.2 ; Mahmoud Alalfy, M.Sc.3

1 Fetal medicine unit, Cairo university, Egypt;
2 Radiodiagnosis department, Kasr Alainy teaching hospitals, Cairo university, Egypt;
3 Obstetric and gynecology department, National research center, Egypt.

 

Case report
 

A 25-year-old woman (G2P1) with unremarkable medical history was referred to our office due to fetal ascites and rapid heart rate. Our ultrasonographic examination revealed the following findings:

Video 1: Transverse sweep starting from the level of the abdomen to the level of the upper mediastinum showing fetal ascites and abnormally high fetal heart rate with normal morphological structures.


Images 1, 2: Image 1 - pulsed Doppler across the left ventricular inflow-outflow showing very rapid heart rate with 1:1 atrioventricular conduction. Absence of E wave denoting extremely shortened diastolic filling time with the presence of only atrial component of atrioventricular inflow (a wave). Image 2 - M-Mode tracing through the right ventricle and the left atrium emphasizing on the electrical concordance (1:1 atrioventricular conduction).

 

Videos 2, 3: Video 2 - oblique sagittal view showing congested right atrium and inferior vena cava (IVC). Video 3 - transverse sweep showing fetal ascites with free floating bowel loops and lower limb edema.

 

Video 4:  B-Flow imaging of the fetal heart showing abnormally increased heart rate.


Images 3, 4:  Surface rendering of the fetal abdominal organs clearly depicting fetal liver with congested umbilical vein on its surface, bowel loops and both kidneys.

 

Video 5: Volume cine with rendered transverse abdominal cuts clearly showing the congested inferior vena cava (IVC), hepatic veins, ductus venosus and umbilical vein.


Images 5, 6, and video 6: Color Doppler showing tricuspid regurgitation. STIC volume with inversion mode showing tricuspid regurgitation (speed was reduced to show the regurgitation) - Image 6 for orientation in the video (MB moderator band, IVS interventricular septum, PV - pulmonary valve).

 


Image 7 and video 7: Color and pulsed Doppler study showing back and forth flow within the IVC, hepatic veins and ductus venosus with predominant regurgitant component (a wave) and small forward component (s wave only). 

 

Image 8, 9, 10, 11, 12, 13 and videos 8, 9, 10, 11 (with reduced speed): STIC acquisition with inversion mode showing predominance of the regurgitation across the IVC, hepatic veins and ductus venosus (Images 8, 9, 10, 11, 12, 13 for orientation in corresponding videos). SVC - superior vena cava, DV - ductus venosus.

 

 

 

 

 

Video 12:  STIC inversion mode of the four chamber view.



The patient was asked to attend our clinic the next morning to start digitalis administration but unfortunately intrauterine fetal demise was found at the time of her visit to our clinic.

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