Changes in echocardiography and blood variables during and after development of Ballantyne syndrome

The diagnostic conundrum of maternal mirror syndrome progressing to pre-eclampsia - A case report

Mirror syndrome, also called Ballantyne syndrome, is a rare condition in pregnancy, defined by the presence of the clinical triad of fetal hydrops, placentomegaly and maternal oedema. Any aetiology of fetal hydrops, including rhesus iso-immunization, congenital infection, twin-to-twin transfusion, structural anomalies and fetal malignancies, can lead to the syndrome. The pathogenesis, although not well established, mimics trophoblastic damage and maternal vascular endothelial dysfunction, as is also seen in pre-eclampsia, and, hence, the two conditions may have a similar clinical presentation. They may even co-exist, where a patient with maternal mirror syndrome develops features of pre-eclampsia. A timely, accurate diagnosis and prompt interventions are needed to prevent fetal mortality and maternal morbidity.

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Mirror syndrome is a rare condition in pregnancy defined by the clinical triad of fetal, placental and maternal hydrops

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The correction of fetal hydrops (and, hence placental hydrops) resolves Mirror syndrome

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The trophoblastic damage caused by placental oedema causes endothelial dysfunction leading to Mirror syndrome

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Although Mirror syndrome and pre-eclampsia have different aetiologies they may have similar presentations and co-exist

Echocardiography findings in a case with Ballantyne syndrome

Marked fluid retention occurs in Ballantyne syndrome, but few reports are available on changes in cardiac morphology in this syndrome. A woman with generalized edema, dyspnea, fetal hydrops (skin edema and ascites), thickened placenta, and elevated plasma B-type natriuretic peptide level (344 pg/mL) was admitted to our hospital at gestational week (GW) 20⁺³ . Blood pressure remained within the normal range. However, acute increases in left atrial volume index, pulmonary artery systolic pressure, and hyperdynamic left ventricular function (as evidenced by increased left ventricular ejection fraction to 74% with cardiac index of 5.1 L/min/m² ) occurred preceding fetal death at GW 21⁺⁴ in the presence of increased inferior vena cava diameter (23 mm) and relatively low systemic vascular resistance of 752 dyn·s/cm⁵ . These findings suggested life-threatening heart failure and required cesarean delivery at GW 21⁺⁵ resulting in complete recovery. The placenta suggested cytomegalovirus infection.