24–28 August 2008, Chicago, USA Poster abstracts A 33-year-old woman, gravida 2 para 2, was refferd to our institution at 35 weeks’ gestation, because of polyhydramnios. Ultarasound examination revealed mild polyhydramnios (amniotic fluid index:25) and juxtaposition of the descending aorta and inferior vena cava. Fetal echocardiography demonstrated a common atrioventricular valve, double outlet right ventricle, pulmonary stenosis. Four pulmonary veins drained to a confluence behind the left atrium arising a vertical vein passed through the diaphragma and then connected to portal vein. On pulsed Doppler examination, the pulmonary veins and vertical vein showed continuous, mildly pulsatile flow. All these features were suggestive of right atrial isomserism with total anomalous pulmonary venous connection to the portal vein. Absence of the ductus venosus without liver bypass was suspected by meticulous color flow mapping of the portal circulation in various planes. A female infant was delivered weighing 2810g with Apgar scores of 8 and 8 at 1 and 5 minutes, respectively. Postnatal echocardiography confirmed the prenatal findings. On pulsed Doppler examination, the vertical vein showed non-pulsatile continuous flow. The infant underwent open heart surgery and the pulmonary confluence was connected to the left atrium. But she died at the second day because of cardiac failure. We speculate absence of the ductus venosus without liver bypass might worsend the prognosis of the infant with total anomalous pulmonary venous connection to the portal vein. P31.07 Maternal complex congenital cardiac defect and fetal tachyarrhythmia M. Small 1 , L. R. Brancazio 1 , M. Decker 1 , B. K. Boyd 1 , B. Fitzpatrick 1 , S. C. Ellestad 1 , E. Livingston 1 , P. Barker 2 1 Maternal Fetal Medicine, Obstetrics and Gynecology, Duke University, Durham, United States, 2 Pediatric Cardiology, Duke University, Durham, United States Objective: Sustained fetal tachyarrhythmias are rare events associated with fetal hydrops, demise and potential adverse neurologic sequela in untreated neonates. Both timing and type of treatment depend on maternal and fetal factors. Optimal agents for fetal therapy minimize maternal risk. We present a rare case of both complex maternal CHD and fetal tachyarrthymia. Case Report: The maternal history was significant for Tetralogy of Fallot, status post Blalock Tausing shunt followed by complete repair and subsequent pulmonary valve replacement with homograft. Baseline maternal cardiac echocardiogram demonstrated mild right heart dilation with normal function. Her new pulmonary valve demonstrated mild stenosis (peak gradient 25 mm) and no pulmonary regurgitation. She had one previous uncomplicated, assisted term vaginal delivery 7 years ago. Fetal echocardiogram at 25 weeks demonstrated structurally normal fetal heart and intermittent, blocked PACS. Follow up fetal echo at 29 weeks gestation demonstrated Chaotic Atrial Tachycardia (CAT), 80% of time with ventricular rate 300s. Maternal oral digoxin therapy was unsuccessful so the patient was started on Metoprolol for conversion. The patient was unable to tolerate Metoprolol secondary to fatigue, symptomatic hypotension and bradycardic episodes. Sotalol was initiated and well tolerated by the patient, however, baseline maternal RBBB made interpretation of QT intervals problematic. At 35 weeks, the fetal tachyarrhythmia predominated again, and the fetus was delivered by cesarean section. Postnatally, the neonate had atrial flutter, which converted with procainamide. At approximately 8 months of age, the neonate is healthy and requires proprafenone for maintenance of normal sinus rhythm. Conclusions: More women with congenital heart defects are reaching reproductive age. Maternal CHD, in the setting of fetal arrhythmia complicated therapy and was a key safety issue in this case. P31.08 Prenatal diagnosis of aorto-pulmonary window, double-outlet right ventricle, and absent pulmonary valve; A case report of immediate neonatal death M. Jujo , J. Kamei, Y. Kanetaka, S. Kozuma, Y. Taketani Department of Obstetrics and Gynecology, The University of Tokyo Hospital, Tokyo, Japan A congenital heart disease with a combination of aorto-pulmonary window (APW), double-outlet right ventricle (DORV), and absent pulmonary valve (APV) is extremely rare and to our best knowledge, has not been reported. Here we report a prenatal diagnosis and perinatal course of a fetus with this combination. A 27-year-old woman, gravida 1, para 1, was referred to our institute at 27 weeks of gestation for the assessment of the cardiac anomalies. Detailed ultrasonography (US) of the fetus revealed a complex cardiac anomalies of a large A-P window, DORV, APV, and ventricular septal defect (VSD). The fetus had no other abnormal findings such as hydropic change, structural anomalies in other organs, and polyhydroamnios. The clinical course of the mother and the fetus was uneventful thereafter, and the induction of labor was scheduled at 39 weeks. The baby girl, 3,280 gr, was born after 8 hrs of induction with oxytocin. In spite of no deteriorating fetal heart rate pattern during labor, the baby had cardiac arrest at birth with Apgar 0(1  f) and 1(5  f), and she died 30 min after birth without any reaction to intensive resuscitation. The autopsy confirmed the prenatal diagnosis with no other anomalies. The baby did not have any abnormal findings in the respiratory tract and the pathogenesis of the sudden neonatal death was not proved. A further accumulation of case reports of similar cases would be informative in the future for the management of the baby with this cardiac anomalies and the explanation to the patient’s family. P31.09 The diagnostic value of 3D XI in the assessment of the interventricular septum L. Tolaymat , G. Grabner Obstetrics & Gynecology, University of Florida, Jacksonville, United States Objective: The aim of this pilot study was to describe the application and potential of 3D Multi-Slice View in demonstrating the detection of ventricular septal defects after 2D imaging failed to recognize these smaller defects. Methods: From a low-risk patient population, routine two- dimensional sonographic examinations were performed using the MEDISON ACCUVIX XQ. Following normal-appearing 2D heart surveys (4CH, RVOT, LVOT, Aortic Arch, and Ductal Arch), 3D volumes of the fetal heart were obtained using 3D extended Imaging with Multi-Slice View with color flow imaging. Results: The 3D XI MSV allowed a simultaneous display of multiple sequential parallel planes of the fetal heart with color flow displayed across the intraventricular septum highlighting small ventricular septal defects that were not seen on a routine concurrent low-risk anatomic survey. Conclusions: The use of 3D XI gives a better understanding of the exact anatomy and size of the ventricular septal defects. This leading-edge diagnostic tool can be adapted into any daily practice because of the short acquisition and reconstruction time. We believe that it may soon become an important component of fetal screening thus helping to display color flow across the intraventricular septum, as well as, retrieve standard cardiac cross sections. Ultrasound in Obstetrics & Gynecology 2008; 32: 398–466 419