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Case Reports
. 2020 Nov;28(4):266-270.
doi: 10.1177/1742271X20933996. Epub 2020 Jun 25.

Fetal bradyarrhythmia causing hydrops fetalis: A journey from fetal echo to autopsy

Arjit Agarwal  1 , Shubhra Agarwal  2 , Astha Lalwani  2 , Rehana Najam  2 , Ashutosh Kumar  2
Affiliations
Case Reports

Fetal bradyarrhythmia causing hydrops fetalis: A journey from fetal echo to autopsy

Arjit Agarwal et al. Ultrasound. 2020 Nov.

Abstract

Introduction: Non-immune hydrops fetalis is a condition with poor fetal prognosis. The incidence of this clinical condition is increasing as compared to its iso-immune variant. The diagnosis of hydrops fetalis is straightforward; however, delineating the primary cause of non-immune hydrops fetalis requires a holistic approach and background knowledge of the entity.

Case report: We present a case of non-immune hydrops fetalis due to a rare functional cardiac disorder demonstrated by features of cardiac failure in the form of clinically significant tricuspid regurgitation detected on echocardiography. Fetal autopsy supported the diagnosis by excluding any structural anomaly.

Discussion: Non-immune hydrops fetalis may be due to structural and non-structural cardiac anomalies. Meticulous work-up is required to establish the diagnosis in such cases.

Conclusion: The case also highlights the systematic approach as well as the series of investigations required for the early diagnosis and management of such cases.

Keywords: Hydrops fetalis; arrhythmia; bradycardia; echocardiography.

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Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Antenatal US images of fetus showing (a) mild ascites, (b) bilateral pleural effusion, and (c) scalp edema.
Figure 2.
Figure 2.
US image of the four-chamber view of the fetal heart with color Doppler shows tricuspid regurgitation. LA: left atrium; LV: left ventricle; RA: right atrium; RV: right ventricle.
Figure 3.
Figure 3.
US image with color Doppler of the heart in long axis (hammock view) showing tricuspid regurgitation. IVC: inferior vena cava; RA: right atrium: RV: right ventricle: RVOT: right ventricular outflow tract; SVC: superior vena cava.
Figure 4.
Figure 4.
Spectral Doppler across the tricuspid valve showing significant regurgitant jet of blood flow with E-wave more than A-wave (E/A >1) indicative of cardiac failure.
Figure 5.
Figure 5.
M-mode of the heart showing bradycardia with discordance of atrial (A) and ventricular (V) beats suggestive of AV-dissociation or complete AV-block.
Figure 6.
Figure 6.
Gross specimen of the abortus showing hydropic changes, scalp edema, and protruding abdomen.
Figure 7.
Figure 7.
Fetal autopsy cross-section of the heart showing normal cardiac morphology with intact ventricular septum and visualization of the outflow tracts.
Figure 8.
Figure 8.
Flowchart of pathogenesis of hydrops fetalis due to fetal arrhythmia.
See this image and copyright information in PMC

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