Mirror syndrome with noncompaction cardiomyopathy in the mother and fetus. Case report
DOI:
https://doi.org/10.18597/rcog.3659Abstract
Objective: To report the case of a pregnant woman with mirror syndrome associated with non-compaction cardiomyopathy in the mother and the fetus, in which antenatal medical treatment provided to the mother resulted in a favorable perinatal maternal outcome.
Case presentation: A 16-year old primigravida with 33 weeks of gestation referred from a Level I institution to a private Level IV center in Medellín, Colombia, because of a finding of fetal hydrops on obstetric ultrasound. During hospitalization, the patient showed clinical and ultrasonographic signs of heart failure (dyspnea, edema and hypoxemia), with the diagnosis of hydrops fetalis (mirror syndrome) also confirmed. Diuretic treatment with furosemide was initiated in the mother, with subsequent improvement of the maternal condition as well as of the fetal edema. During the subacute postpartum period in the hospital, the presence of non-compaction cardiomyopathy was confirmed on cardiac nuclear magnetic resonance imaging in both the mother and the newborn. After discharge in adequated condition, they were included in the cardiovascular follow-up program for heart failure and congenital heart disease, respectively.
Conclusion: A case of mirror syndrome associated with maternal and fetal non-compaction cardiomyopathy is presented. There is a limited number of reports on mirror syndrome due to cardiac anomalies (maternal and fetal), with weak treatment descriptions, pointing to the need for research in this area. It would be important to consider the diagnosis of non-compaction cardiomyopathy in fetuses with hydrops unrelated to isoimmunization or cardiac dysfunction, and approach these cases from a multi-disciplinary perspective.
Author Biographies
Jesús Arnulfo Velásquez-Penagos, Hospital Universitario San Vicente Fundación, Medellín (Colombia).
Docente departamento de Ginecología y obstetricia, Facultad de Medicina - Universidad de Antioquia.
Ginecoobstetra Hospital Universitario San Vicente Fundación
Edison Muñoz-Ortiz, Hospital Universitario San Vicente Fundación, Medellín (Colombia).
Cardiologo Fundación Universitaria San Vicente Fundación.
Docente, sección cardiología, Facultad de Medicina - Universidad de Antioquia
Jairo Alfonso Gándara-Ricardo, Hospital Universitario San Vicente Fundación, Medellín (Colombia).
Cardiologo, Hospital Universitario San Vicente Fundación.
Juan Pablo Flórez-Muñoz, Hospital Universitario San Vicente Fundación, Medellín (Colombia).
Cardiologo - Ecocardiografista. Hospital Universitario San Vicente Fundación.
Erika Holguín-González, Hospital Universitario San Vicente Fundación, Medellín (Colombia).
Anestesiologa. Hospital Universitario San Vicente Fundación.
References
Ballantyne JW. The disease and deformities of the fetus. Oliver & Boyd, editor. Edinburgh; 1892.
Braun T, Brauer M, Fuchs I, Czernik C, Dudenhausen JW, Henrich W, et al. Mirror Syndrome: A Systematic Review of Fetal Associated Conditions, Maternal Presentation and Perinatal Outcome. Fetal Diagn Ther. 2010;27(4):191–203. https://doi.org/10.1159/000305096
Zhao Y, Liu G, Wang J, Yang J, Shen D, Zhang X. Mirror syndrome in a Chinese hospital: diverse causes and maternal fetal features. J Matern Neonatal Med. 2013;26(3):254–8. https://doi.org/10.3109/14767058.2012.733765
Chen R, Liu M, Yan J, Chen F, Han Q, Zheng L, et al. Clinical characteristics of mirror syndrome: a retrospective study of 16 cases. J Obstet Gynaecol (Lahore). 2020;1–4. https://doi.org/10.1080/01443615.2020.1718621
Hobson SR, Wallace EM, Chan YF, Edwards AG, Teoh MWT, Khaw AP-L. Mirroring preeclampsia: the molecular basis of Ballantyne syndrome. J Matern Neonatal Med. 2020;33(5):768–73. https://doi.org/10.1080/14767058.2018.1500550
Goa S, Mimura K, Kakigano A, Tomimatsu T, Kinugasa-Taniguchi Y, Endo M, et al. Normalisation of Angiogenic Imbalance after Intra-Uterine Transfusion for Mirror Syndrome Caused by Parvovirus B19. Fetal Diagn Ther. 2013;34(3):176–9. https://doi.org/10.1159/000348778
Gruson D, Hermans MP, Ferracin B, Ahn SA, Rousseau MF. Sflt-1 in heart failure: relation with disease severity and biomarkers. Scand J Clin Lab Invest. 2016;76(5):411–6. https://doi.org/10.1080/00365513.2016.1190863
Gherman RB, Incerpi MH, Wing DA, Goodwin TM. Ballantyne syndrome: is placental ischemia the etiology? J Matern Fetal Med. 1998;7(5):227–9. https://doi.org/10.3109/14767059809020448
Hirata G, Aoki S, Sakamaki K, Takahashi T, Hirahara F, Ishikawa H. Clinical characteristics of mirror syndrome: a comparison of 10 cases of mirror syndrome with non-mirror syndrome fetal hydrops cases. J Matern Fetal Neonatal Med. 2016;29(16):2630–4. https://doi.org/10.3109/14767058.2015.1095880
Bie P. Natriuretic Peptides and Normal Body Fluid Regulation. In: Comprehensive Physiology. Hoboken, NJ, USA: John Wiley & Sons, Inc.; 2018. p. 1211–49. https://doi.org/10.1002/cphy.c180002
Miyoshi T, Hosoda H, Miyazato M, Kangawa K, Yoshimatsu J, Minamino N. Metabolism of atrial and brain natriuretic peptides in the fetoplacental circulation of fetuses with congenital heart diseases. Placenta. 2019;83:26–32. https://doi.org/10.1016/j.placenta.2019.06.382
Lee SM, Jun JK, Kim SA, Kang MJ, Song SH, Lee J, et al. N-terminal pro-B-type natriuretic peptide and cardiac troponin T in non-immune hydrops. J Obstet Gynaecol Res. 2016 Apr;42(4):380–4. https://doi.org/10.1111/jog.12920
Cameron VA, Ellmers LJ. Minireview: Natriuretic Peptides during Development of the Fetal Heart and Circulation. Endocrinology. 2003;144(6):2191–4. https://doi.org/10.1210/en.2003-0127
Chimenea A, García-Díaz L, Calderón AM, Heras MM-D Las, Antiñolo G. Resolution of maternal Mirror syndrome after succesful fetal intrauterine therapy: a case series. BMC Pregnancy Childbirth. 2018;18(1):85. https://doi.org/10.1186/s12884-018-1718-0
Nassr AA, Shamshirsaz AA, Belfort MA, Espinoza J. Spontaneous resolution of mirror syndrome following fetal interventions for fetal anemia as a consequence of twin to twin transfusion syndrome. Eur J Obstet Gynecol Reprod Biol. 2017;208:110–1. https://doi.org/10.1016/j.ejogrb.2016.11.023
Allarakia S, Khayat HA, Karami MM, Aldakhil AM, Kashi AM, Algain AH, et al. Characteristics and management of mirror syndrome: a systematic review (1956–2016). J Perinat Me. 2017;45(9). https://doi.org/10.1515/jpm-2016-0422
Livingston JC, Malik KM, Crombleholme TM, Lim F-Y, Sibai BM. Mirror syndrome: a novel approach to therapy with fetal peritoneal-amniotic shunt. Obstet Gynecol. 2007;110(2 Pt 2):540–3. https://doi.org/10.1097/01.AOG.0000275259.03301.b2
Kosinski P, Krajewski P, Wielgos M, Jezela-Stanek A. Nonimmune Hydrops Fetalis—Prenatal Diagnosis, Genetic Investigation, Outcomes and Literature Review. J Clin Med. 2020;9(6):1789. https://doi.org/10.3390/jcm9061789
Grant R. An unusual anomaly of the coronary vessels in the malformed heart of a child. Heart. 1926;13:273–83.
Towbin JA, Lorts A, Jefferies JL. Left ventricular non-compaction cardiomyopathy. Lancet. 2015;386(9995):813–25. https://doi.org/10.1016/S0140-6736(14)61282-4
Fazio G, Lunetta M, Grassedonio E, Gullotti A, Ferro G, Bacarella D, et al. Noncompaction of the Right Ventricle. Pediatr Cardiol. 2010;31(4):576–8. https://doi.org/10.1007/s00246-010-9652-6
Murphy RT, Thaman R, Blanes JG, Ward D, Sevdalis E, Papra E, et al. Natural history and familial characteristics of isolated left ventricular non-compaction. Eur Heart J. 2005;26(2):187–92. https://doi.org/10.1093/eurheartj/ehi025
Sandhu R, Finkelhor RS, Gunawardena DR, Bahler RC. Prevalence and Characteristics of Left Ventricular Noncompaction in a Community Hospital Cohort of Patients with Systolic Dysfunction. Echocardiography. 2007;25(1):8–12 https://doi.org/10.1111/j.1540-8175.2007.00560.x
Maron BJ, Towbin JA, Thiene G, Antzelevitch C, Corrado D, Arnett D, et al. Contemporary definitions and classification of the cardiomyopathies: an American Heart Association Scientific Statement from the Council on Clinical Cardiology, Heart Failure and Transplantation Committee; Quality of Care and Outcomes Research and Functio. Circulation. 2006;113(14):1807–16. https://doi.org/10.1161/CIRCULATIONAHA.106.174287
Elliott P, Andersson B, Arbustini E, Bilinska Z, Cecchi F, Charron P, et al. Classification of the cardiomyopathies: a position statement from the European Society Of Cardiology Working Group on Myocardial and Pericardial Diseases. Eur Heart J. 2008 ;29(2):270–6. https://doi.org/10.1093/eurheartj/ehm342
Richardson P, McKenna W, Bristow M, Maisch B, Mautner B, O’Connell J, et al. Report of the 1995 World Health Organization/International Society and Federation of Cardiology Task Force on the Definition and Classification of cardiomyopathies. Circulation. 1996;93(5):841–2. https://doi.org/10.1161/01.CIR.93.5.841
Sun H, Hao X, Wang X, Zhou X, Zhang Y, Liu X, et al. Genetics and Clinical Features of Noncompaction Cardiomyopathy in the Fetal Population. Front Cardiovasc Med. 2020;7:617561. https://doi.org/10.3389/fcvm.2020.617561
Tian L, Zhou Q, Zhou J, Zeng S, Cao D, Zhang M. Ventricular non-compaction cardiomyopathy: prenatal diagnosis and pathology. Prenat Diagn. 2015;35(3):221–7. https://doi.org/10.1002/pd.4523
Nugent AW, Daubeney PEF, Chondros P, Carlin JB, Cheung M, Wilkinson LC, et al. The epidemiology of childhood cardiomyopathy in Australia. N Engl J Med. 2003;348(17):1639–46. https://doi.org/10.1056/NEJMoa021737
Charron P, Elliott PM, Gimeno JR, Caforio ALP, Kaski JP, Tavazzi L, et al. The Cardiomyopathy Registry of the EURObservational Research Programme of the European Society of Cardiology: baseline data and contemporary management of adult patients with cardiomyopathies. Eur Heart J. 2018;39(20):1784–93. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/29378019
Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J, Blomström-Lundqvist C, Cífková R, De Bonis M, et al. 2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy. Eur Heart J. 2018;39(34):3165–241. Disponible en: https://academic.oup.com/eurheartj/article/39/34/3165/5078465
Stöllberger C, Wegner C, Finsterer J. Fetal Ventricular Hypertrabeculation/Noncompaction: Clinical Presentation, Genetics, Associated Cardiac and Extracardiac Abnormalities and Outcome. Pediatr Cardiol. 2015;36(7):1319–26. https://doi.org/10.1007/s00246-015-1200-y
Kilic ID, Tanriverdi H, Evrengul H, Uslu S, Sungur MA. Left ventricular non-compaction in pregnancy : case report - online article. Cardiovasc J Afr. 2013;24(3):e1–2. https://doi.org/10.5830/CVJA-2012-075
Kayançiçek H, Alataş Ö, Doğan ÖF. De novo left ventricular non-compaction accompanied by severe mitral valve failure in a young pregnant. Turk gogus kalp damar cerrahisi Derg. 2018;26(2):292–5. https://doi.org/10.5606/tgkdc.dergisi.2018.15676
Gherbesi E, Bonanomi C, Bottari V, Danzi GB. Ventricular tachycardia triggered by pregnancy in left-ventricular non-compaction cardiomyopathy: a controversial indication to automated defibrillator implantation. Monaldi Arch Chest Dis. 2020;90(3). https://doi.org/10.4081/monaldi.2020.1280
Beermann B, Groschinsky-Grind M, Fåhraeus L, Lindström B. Placental transfer of furosemide. Clin Pharmacol Ther. 1978 Nov;24(5):560–2. https://doi.org/10.1002/cpt1978245560
How to Cite
Downloads
Downloads
Published
Issue
Section
| Article metrics | |
|---|---|
| Abstract views | |
| Galley vies | |
| PDF Views | |
| HTML views | |
| Other views | |
