Case Report: 5 Cases of Variant Hypoplastic Left Heart Syndrome Diagnosed on Prenatal Fetal Ultrasound

Case series Patients: Female, 38-year-old • Female, 41-year-old • Female, 36-year-old • Female, 43-year-old • Female, 30-year-old Final Diagnosis: Hypoplastic left heart syndrome Symptoms: Heart failure Clinical Procedure: — Specialty: Obstetrics and Gynecology OBJECTIVE: Congenital defects/diseases BACKGROUND: Hypoplastic left heart syndrome (HLHS) is a complex left-sided obstructive congenital cardiac condition with several variants. This report is of 5 cases with varying morphology of HLHS diagnosed by fetal prenatal ultra-sound at the 4-chamber view (4CV) level. CASE REPORTS: Five cases were referred by obstetrics and gynecology specialists with preliminary information on visible congenital abnormalities in the third trimester. Fetal echocardiography showed that several morphological variants of HLHS were found. The patient in the first case had the most frequently found variant; this variation is usually linked to mitral valve stenosis (MVS). The second case had the characteristic of mitral valve atresia (MVA), and as a consequence, blood flow was not visible in this variant and the left ventricle (LV) was not clear or not adequately visualized by ultrasound. In the third case, the patient suffered from severe MVS and perhaps a small aorta. Uni-atrial conditions were described in the third case. In the fourth case, the patient had a narrow LV, MVA, ventricular septal defect, nearly united atrium, and tricuspid regurgitation. The fifth case was a case of HLHS with congenital diaphragmatic hernia. Further, 4 out of 5 of the cases were associated with widening of the cisterna magna and Dandy Walker syndrome-associated posterior fossa disorder malformations. The overall maternal age was over 35 years old in 4 cases. Karyotyping examination was not performed in all cases. CONCLUSIONS: The role of ultrasound is very important in determining the diagnosis and the degree of development of hypo-plastic LV. However, visualization at the 4CV level can detect abnormalities found in the LV.