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2018-01-17  Combined valvular aortic and pulmonary stenosis  © Ahmed Ezz  www.TheFetus.net

Combined valvular aortic and pulmonary stenosis
Fetal medicine unit – Cairo university- Egypt


Case report

A female patient (G3P2) with unremarkable history, no consanguinity and two previous normal child, came to our unit at 30 weeks of pregnancy for routine ultrasound.
 
Our examination revealed an a
ortic valve with thickened valve leaflets, and lack of complete valve opening during systole with post- stenotic dilation of ascending aorta; color Doppler shows turbulent flow across the aortic valve and pulsed Doppler reveals high peak systolic velocity of greater than  200 cm/sec.
Pulmonary valve was seen echogenic , with abnormal excursion, thickened & dysplastic. Valve leaflets were visible within the pulmonary artery throughout the cardiac cycle with post stenotic dilation. Color Doppler shows turbulent flow across the pulmonary valve  and pulsed Doppler reveals high peak systolic velocity of greater than 200 cm/sec.

Based on our ultrasound and Doppler findings, the diagnosis was combined valvular aortic  and valvular pulmonary  stenosis  (mild form for both lesion).

 
The patient delivered by C section ( at tertiary centre )  and baby was fine post natallly, with no need for incubator.
Combined valvular aortic  stenosis and valvular pulmonary  stenosis was confirmed after birth and the baby is doing well until now.
 
 
 

Image 1 and 2: four chamber view during systole &and diastole looks normal.

 


Image 3: three vessels view shows large size of aorta and pulmonary artery in relation to superior vena cava (due to post stenotic dilation).

 


Image 4: forward flow through mitral and tricuspid valves.

 


Image 5: forward flow through 3 vessels.

 


Image 6: shows flow through stenotic aorta.

 


Images  7 and 8: pulsed Doppler shows high velocity through aortic valve (above 200cm/sec).

 


Image 9 and 10: pulsed Doppler shows high velocity through pulmonary artery ( about 225cm /sec).

 


Image 11: 3D using  tomographic ultrasound imaging with volume contrast imaging.
Hands  show aorta dilation as going from 4 chamber view towards 3 vessels view.
Arrows show  stenotic pulmonary artery and post stenotic dilation as going from right ventricular out flow towards 3 vessels view.




Videos 1, 2 and 3:  show crossing of great arteries and show the thickened echogenic limited opening of valves ( aorta  and pulmonary) with post stenotic dilation.
  


Video 4: shows 3 vessel view and dilated pulmonary and aorta in relation to superior vena cava.

                     


Video 5: flow at 4 chamber view.

 


Video 6: flow through stenosed aortic valve. 

 


Video 7
: forward high velocity flow at 3 vessel view.



 

   

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