Home Monitoring for Fetal Heart Rhythm During Anti-Ro Pregnancies
Bettina F. Cuneo, Sven-Erik Sonesson, Stephanie Levasseur, Anita J. Moon-Grady, Anita Krishnan, Mary T. Donofrio, Marie-Josee Raboisson, Lisa K. Hornberger, Peter Van Eerden, Elena Sinkovskaya, Alfred Abuhamad, Bhawna Arya, Anita Szwast, Helena Gardiner, Katherine Jacobs, Grace Freire, Lisa Howley, Aimee Lam, Alexander M. Kaizer, D. Woodrow Benson and Edgar Jaeggi
(A) Four-chamber view showing a prominent papillary muscle in the right ventricle (RV) (circle). (B) Mitral inflow is biphasic, and the atrioventricular (AV) interval is normal (117 ms). (C) Three days later, the endocardial fibroelastosis is obvious and extensive, involving both atrioventricular valves, the proximal portion of the intraventricular septum, and the right atrium (RA). The left atrium (LA) is not clearly seen. (D) The mitral inflow Doppler pattern has become monophasic. (E) Simultaneous superior vena cava and aorta Doppler image showing that the irregular rhythm heard by fetal heart rate monitoring is type 1, second-degree atrioventricular block. The last conducted atrial beat is shown by the yellow arrow on the left. The next atrial contraction is not conducted (white arrow), but afterward there is a period of atrioventricular conduction with gradually prolonging atrioventricular intervals. (F) After treatment with dexamethasone and intravenous immunoglobulin, at 23 weeks, the tricuspid insufficiency has resolved, and endocardial fibroelastosis has improved, but is still visible. (G) The mitral inflow is once again biphasic, and the atrioventricular interval is again normal. LV = left ventricle.