{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,12]],"date-time":"2025-11-12T03:21:25Z","timestamp":1762917685550,"version":"3.40.4"},"reference-count":19,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2016,6,2]]},"abstract":"<jats:p>We report a pregnant woman who was monitored by echocardiography and determination of blood variables, including components of the renin\u2013angiotensin\u2013aldosterone system (RAAS), cardiac biomarkers and soluble fms-like tyrosine kinase-1 (sFlt-1), during and after the development of Ballantyne syndrome. Generalised maternal oedema with dyspnoea following fetal and placental hydrops necessitated a caesarean section at 33\u2005weeks of gestation. Changes in blood variables and simultaneous echocardiography changes indicated acutely enhanced RAAS and hyperdynamic left ventricular function in response to excessive volume overload (as evidenced by brain-type natriuretic peptide level of 523\u2005pg\/mL) in the absence of increased systemic vascular resistance. Elevated sFlt-1 (15\u2005600\u2005pg\/mL) and human chorionic gonadotrophin (404\u2005000\u2005IU\/L) levels were also noted. The increased plasma aldosterone concentration (2070\u2005pg\/mL) may have been responsible for the increase in circulating plasma volume, and the increased sFlt-1 level was responsible for generalised maternal oedema. It remains unclear which factor(s) triggered RAAS activation.<\/jats:p>","DOI":"10.1136\/bcr-2016-216012","type":"journal-article","created":{"date-parts":[[2016,6,22]],"date-time":"2016-06-22T18:34:29Z","timestamp":1466620469000},"page":"bcr2016216012","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Changes in echocardiography and blood variables during and after development of Ballantyne syndrome"],"prefix":"10.1136","volume":"2016","author":[{"given":"Takeshi","family":"Umazume","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mamoru","family":"Morikawa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takahiro","family":"Yamada","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hisanori","family":"Minakami","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2016,6,21]]},"reference":[{"key":"2025042703365773000_2016.jun21_1.bcr2016216012.1","doi-asserted-by":"publisher","DOI":"10.1159\/000305096"},{"key":"2025042703365773000_2016.jun21_1.bcr2016216012.2","first-page":"2630","article-title":"Clinical characteristics of mirror syndrome: a comparison of 10 cases of mirror syndrome with non-mirror syndrome fetal hydrops cases","volume":"29","author":"Hirata","year":"2016","journal-title":"J Matern Fetal Neonatal Med"},{"key":"2025042703365773000_2016.jun21_1.bcr2016216012.3","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1515\/jpm-2013-0211","article-title":"Gestational weight gain according to number of fetuses in Japanese women","volume":"42","author":"Morikawa","year":"2014","journal-title":"J Perinat Med"},{"key":"2025042703365773000_2016.jun21_1.bcr2016216012.4","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-196507000-00004"},{"key":"2025042703365773000_2016.jun21_1.bcr2016216012.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.mam.2007.03.002"},{"key":"2025042703365773000_2016.jun21_1.bcr2016216012.6","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1016\/j.preghy.2013.08.002","article-title":"Association of NT-proBNP with plasma renin activity and plasma aldosterone concentration in women with singleton pregnancy","volume":"4","author":"Yamada","year":"2014","journal-title":"Pregnancy Hypertens"},{"key":"2025042703365773000_2016.jun21_1.bcr2016216012.7","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200411183512123"},{"key":"2025042703365773000_2016.jun21_1.bcr2016216012.8","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa031884"},{"key":"2025042703365773000_2016.jun21_1.bcr2016216012.9","doi-asserted-by":"publisher","DOI":"10.1007\/s10654-015-0039-0"},{"key":"2025042703365773000_2016.jun21_1.bcr2016216012.10","doi-asserted-by":"publisher","DOI":"10.1152\/ajpheart.00966.2001"},{"key":"2025042703365773000_2016.jun21_1.bcr2016216012.11","doi-asserted-by":"publisher","DOI":"10.3109\/10641955.2011.638957"},{"key":"2025042703365773000_2016.jun21_1.bcr2016216012.12","doi-asserted-by":"publisher","DOI":"10.1159\/000089056"},{"key":"2025042703365773000_2016.jun21_1.bcr2016216012.13","doi-asserted-by":"publisher","DOI":"10.1016\/j.mce.2006.06.014"},{"key":"2025042703365773000_2016.jun21_1.bcr2016216012.14","doi-asserted-by":"publisher","DOI":"10.1080\/14767050600922677"},{"key":"2025042703365773000_2016.jun21_1.bcr2016216012.15","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000248538.03280.cf"},{"key":"2025042703365773000_2016.jun21_1.bcr2016216012.16","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMc052721"},{"key":"2025042703365773000_2016.jun21_1.bcr2016216012.17","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000263776.46071.d1"},{"key":"2025042703365773000_2016.jun21_1.bcr2016216012.18","doi-asserted-by":"publisher","DOI":"10.1172\/JCI200317189"},{"key":"2025042703365773000_2016.jun21_1.bcr2016216012.19","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9378(98)70255-8"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2016-216012","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,27]],"date-time":"2025-04-27T10:37:01Z","timestamp":1745750221000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2016-216012"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,6,21]]},"references-count":19,"alternative-id":["10.1136\/bcr-2016-216012"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2016-216012","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2016,6,21]]}}}