Coronary arteriovenous fistula causing hydrops fetalis

Area of Science:

• Cardiology
• Neonatal Medicine
• Pediatric Cardiology

Background:

• Systemic arteriovenous fistulas can lead to fetal heart failure and hydrops fetalis due to increased cardiac output.
• While fistulas in the CNS, liver, bone, and vascular tumors are known causes, coronary arteriovenous fistula (CAVF) has not been previously reported as a cause of fetal heart failure.
• Coronary arteriovenous fistula is a rare congenital heart disease, accounting for 0.2-0.4% of cases even in postnatal life.

Purpose of the Study:

• To report a rare case of fetal hydrops fetalis caused by a coronary arteriovenous fistula.
• To highlight the potential of coronary arteriovenous fistula as an unrecognized cause of intrauterine heart failure.
• To increase awareness among clinicians regarding this specific etiology of fetal cardiac compromise.

Main Methods:

• Case report of a neonate presenting with hydrops fetalis.
• Review of literature concerning arteriovenous fistulas and fetal heart failure.
• Detailed echocardiographic and clinical assessment of the neonate.

Main Results:

• The neonate presented with hydrops fetalis during the third trimester of pregnancy.
• A coronary arteriovenous fistula between the left main coronary artery and the right ventricular apex was identified.
• This finding suggests a previously unreported cause for fetal heart failure and hydrops fetalis.

Conclusions:

• Coronary arteriovenous fistula should be considered in the differential diagnosis of fetal heart failure and hydrops fetalis.
• Early recognition and diagnosis of coronary arteriovenous fistula are crucial for appropriate management and improved outcomes.
• This case expands the known spectrum of congenital causes for fetal cardiac dysfunction.