case_images: PMC9280093_01
case_images: (a) Four-chamber view showing hyperechoic endocardium, papillary muscle, and pericardial effusion. (b) Sagittal view showing hyperechoic atrioventricular valves
case_images: APC-15-67-g001.jpg
case_images: PMC9280093_01_APC-15-67-g001.jpg
case_images: F1
case_images: The four-chamber view showed moderate pericardial effusion, hyperechoic endocardium, papillary muscles, and both atrioventricular valve annuli [Figure 1a and b].
case_images: (a) Left ventricle inflow-outflow Doppler showing presystolic forward flow into the aorta (yellow arrow). This finding suggests increased stiffness of the left ventricle due to endocardial inflammation resulting in a significant increase in left ventricular pressure during left atrial contraction leading to presystolic forward flow into the aorta. (b) Left ventricle inflow-outflow Doppler showing forward flow into the aorta (yellow arrow) during the isovolumetric contraction time
case_images: APC-15-67-g002.jpg
case_images: PMC9280093_01_APC-15-67-g002.jpg
case_images: F2
case_images: There was ventricular diastolic dysfunction as evident in the left ventricle inflow-outflow Doppler (presystolic flow in ascending aorta) [Figure 2a and b] with no atrioventricular valve regurgitation.
case_images: Left ventricle inflow-outflow Doppler showing sinus bradycardia with atrioventricular interval of 183 ms
case_images: APC-15-67-g003.jpg
case_images: PMC9280093_01_APC-15-67-g003.jpg
case_images: F3
case_images: Left ventricle inflow-outflow Doppler showed periods of fetal sinus bradycardia [Figure 3] alternating with frequent conducted atrial ectopics triggering episodic atrial tachyarrhythmia.
case_images: Left brachiocephalic vein-aorta Doppler demonstrating the beginning of the tachyarrhythmia triggered by an atrial ectopic (pink arrow) and termination of the tachyarrhythmia followed by an atrial ectopic (blue arrow) and bradycardia. It is a long ventriculoatrial tachyarrhythmia (atrioventricular interval 267 ms; ventriculoatrial interval 600 ms) with 1:1 atrioventricular conduction
case_images: APC-15-67-g004.jpg
case_images: PMC9280093_01_APC-15-67-g004.jpg
case_images: F4
case_images: It was a 1:1 long VA tachyarrhythmia (VA interval 600 ms, AV interval 267 ms) triggered by an atrial ectopic, and spontaneous termination of the tachyarrhythmia followed by an atrial ectopic and bradycardia [Figure 4].
case_images: (a) Four chamber view and (b) Sagittal view of the fetal heart showing disappearance of pericardial effusion after steroid therapy. (c) Left ventricle inflow-outflow Doppler showing disappearance of presystolic forward flow into the aorta suggestive of improved diastolic function and persistence of tachycardia-bradycardia
case_images: APC-15-67-g005.jpg
case_images: PMC9280093_01_APC-15-67-g005.jpg
case_images: F5
case_images: Reassessment after 1 week showed absent pericardial effusion and improved ventricular diastolic function [Figure 5].