Coexistence of Suspected Tetralogy of Fallot With Absent Pulmonary Valve and Dextrocardia in Pre‐Gestational Diabetes Mellitus: A Case Report

Figures

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  FIGURE 1. Axial fetal echocardiographic image demonstrates situs solitus with dextrocardia, showing rightward cardiac apex orientation.

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  FIGURE 2. Axial echocardiographic view demonstrates dextrocardia with ventricular inversion and right ventricular free wall hypertrophy (yellow arrow).

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  FIGURE 3. Left ventricular outflow tract view demonstrates a large subaortic ventricular septal defect (VSD) with overriding aorta, consistent with a conotruncal malformation.

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  FIGURE 4. Right ventricular outflow tract view demonstrates rudimentary ridges with absence of normal pulmonary valve leaflets, suggestive of the absent pulmonary valve variant.

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  FIGURE 5. Axial view of the main pulmonary artery (PA) demonstrates marked dilation of the vessel and its left branch (LPA), with non‐visualization of the right pulmonary artery (RPA).

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  FIGURE 6. Color Doppler imaging in the axial view demonstrates significant pulmonary regurgitation (PR) with diastolic retrograde flow in the main PA.

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  FIGURE 7. Spectral Doppler tracing of the pulmonary artery demonstrates severe pulmonary stenosis (PS) with prominent regurgitant diastolic flow (PR).

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  FIGURE 8. Dilated pulmonary artery with rudimentary pulmonary valve ridges (arrows).

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  FIGURE 9. Follow‐up axial echocardiographic view obtained several weeks later demonstrates massive cardiomegaly, biventricular hypertrophy, and bilateral pleural effusions (PLE).

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  FIGURE 10. Sagittal sonographic view of the fetus demonstrates marked ascites (yellow arrows), consistent with evolving hydrops fetalis.