case_images: PMC5313352_01
case_images: The left ventricular outflow tract view of the heart at 24.1 weeks showing the thickening of the aortic valve (arrow in A), with turbulent flow across the aortic valve annulus on a color Doppler image (B). Follow-up evaluation at 26.1 weeks showing the retrograde flow in the aortic arch (C). aAo, ascending aorta; LV, left ventricle; dAo, descending aorta; AA, aortic arch.
case_images: ogs-60-106-g001.jpg
case_images: PMC5313352_01_ogs-60-106-g001.jpg
case_images: F1
case_images: The left ventricular outflow tract view revealed a thickened aortic valve with post-stenotic dilatation of the ascending aorta, and the color Doppler revealed turbulent flow across the aortic valve (Fig. 1A, B). The patient was followed up every two weeks and the ultrasonographic evaluation at 26.1 weeks revealed a newly appeared left-to-right shunt across the foramen ovale, monophasic mitral valve inflow and retrograde flow in the aortic arch (Fig. 1C).
case_images: The ultrasonographic findings reveal that the cannula is located in the LV (open arrow in A), and the thickened aortic valve is demonstrated (solid arrow in A). Immediately after the balloon dilation, the ultrasonographic findings demonstrate the increased forward flow across the aortic valve (B), and a newly developed aortic regurgitation by color Doppler (C). Lt, left; Rt, right; LA, left atrium; LV, left ventricle; aAo, ascending aorta.
case_images: ogs-60-106-g002.jpg
case_images: PMC5313352_01_ogs-60-106-g002.jpg
case_images: F2
case_images: Under continuous ultrasound guidance, a 15-cm-long 14-gauge cannula with a stylet needle was introduced into the fetal LV at the apex (Fig. 2A). Immediately following balloon dilation, we confirmed the increased amount of flow across the aortic valve, and a newly developed aortic regurgitation by color Doppler (Fig. 2B, C).