An enhancement of coronary blood flow in a fetus with supraventricular tachycardia
| Autor: | Somchai Prechawat, Dhiraphongs Charoenvidhya, Saknan Manotaya, Boonchai Uerpairojkit, Somchai Tanawattanacharoen |
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| Rok vydání: | 2009 |
| Předmět: |
Adult
Male medicine.medical_specialty Fetal Membranes Premature Rupture Inferior vena cava Ultrasonography Prenatal Pregnancy Internal medicine medicine Tachycardia Supraventricular Humans Sinus rhythm Genetics (clinical) Fetus Flecainide medicine.diagnostic_test business.industry Infant Newborn Obstetrics and Gynecology Blood flow medicine.disease medicine.anatomical_structure medicine.vein Anesthesia cardiovascular system Cardiology Female Supraventricular tachycardia business Fetal echocardiography Anti-Arrhythmia Agents Ductus venosus Artery |
| Zdroj: | Prenatal diagnosis. 29(3) |
| ISSN: | 0197-3851 |
| Popis: | Modern obstetric ultrasound has allowed a detailed evaluation of many fetal small arteries in both normal and abnormal conditions. Recently, a study of a very tiny fetal coronary artery has been proved possible when the imaging condition is optimal (Baschat et al., 1997). An augmentation of fetal coronary blood flow reflecting an attempt to compensate for an increase in oxygen demand by means of autoregulation process has been demonstrated with Doppler ultrasound in both acute and chronic fetal stress conditions such as acute fetomaternal hemorrhage, fetal ductal constriction, and intrauterine growth restriction (IUGR) (Baschat et al., 2003). We present herein the first case of coronary blood flow enhancement in a fetus with supraventricular tachycardia (SVT) demonstrated with Doppler ultrasound. The evidence of the enhancement of blood flow disappeared when the fetal heart rate was eventually converted to normal sinus rhythm with maternal ingestion of flecainide. A 26-year-old pregnant woman, gravida 1, was referred to our high-risk pregnancy clinic at 29 weeks’ gestation for a rapid fetal heart rate detected at prenatal clinic. Our sonographic examination revealed a fetal biometry consistent with gestational age. No structural anomaly was noted. Fetal echocardiography demonstrated a normal cardiac anatomy. A rapid heart rate of 220–240 bpm with 1-to-1 atrioventricular conduction was noted in M-mode. Color Doppler ultrasound clearly demonstrated a holosystolic tricuspid regurgitation and a prominent coronary blood flow (Figure 1a). Spectral Doppler showed an increased inferior vena cava (IVC) reversed flow at atrial contraction and an intact ductus venosus waveform. A biphasic coronary waveform with a diastolic peak flow of 45.5 cm/s was noted (Figure 1b). Fetal SVT was diagnosed and the fetus was initially treated with maternal ingestion of digoxin. The fetal heart rate resisted converting to sinus rhythm after 5 days when maternal digitalis level reached the therapeutic range of 1.2 ng/mL.Treatment was then switched |
| Databáze: | OpenAIRE |
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