Aorta Larger Than Pulmonary Artery in the Fetal 3‐Vessel View

Abstract

Objective. Fetal great artery asymmetry may accompany congenital heart disease. The fetal echocardiographic 3-vessel view (3VV) allows assessment of the superior vena cava, ascending aorta (AA), and main pulmonary artery (MPA). Our aim was to determine the association of congenital heart disease in fetuses with an AA/MPA ratio of greater than 1. Methods. We electronically searched our fetal echocardiographic database for studies performed between March 2002 and January 2008 that showed 3VVs with AA/MPA ratios of greater than 1 and correlated the findings with the presence of congenital heart disease. Results. In 2797 fetal echocardiograms, we identified 31 fetuses with normal 4-chamber views showing AA/MPA ratios of greater than 1 in the 3VV. Of 31 fetuses, 25 (81%) had tetralogy of Fallot (ToF) or a ToF variant, and 6 (19%) had an aortic valve abnormality or isolated dilatation of the AA. Conclusions. Screening obstetric fetal sonography showing a 3VV AA/MPA ratio of greater than 1 suggests congenital heart disease and indicates the need for comprehensive fetal echocardiography.

Fetal aorta larger than the main pulmonary artery on the three-vessel view: Correlation with postnatal echocardiographic findings

“…Previous studies reported that a larger AA in comparison with the MPA on the 3VV was associated with various CHDs, such as hypoplastic left heart syndrome, coarctation of the aorta, Ebstein's malformation, and ToF . In a study of fetuses with an AA larger than the MPA on the 3VV, 25 of 31 fetuses had ToF or a ToF variant . In contrast with these studies, some studies suggested that the AA could be the same size or larger than the MPA in healthy fetuses .…”

The effect of the introduction of the three‐vessel view on the detection rate of transposition of the great arteries and tetralogy of Fallot

“…A possible explanation could be that the encountered abnormalities in the 3VV can be subtle in ToF (Figure C). The configuration of the vessels is relatively normal in ToF, and the size of the pulmonary trunk in fetal life can be normal to only slightly decreased . The key to the diagnosis in ToF cases with a relatively normal sized pulmonary artery is the more anterior positioned aorta in the 3VV.…”

Role of the 3‐Vessel and Trachea View in Antenatal Detection of Tetralogy of Fallot

“…This finding was in contrast to a recently published series of 43 fetuses with tetralogy of Fallot, in which all outflow tract-derived aortic annulus Z scores were greater than 2.0. 22 One explanation for the discrepancies between those results and the results of our study may be the method of Z score calculation, as we used the logarithmic transformation described by Schneider et al 22,24,25 Indeed, the results of other studies, including that of Rollins et al, 20 have also suggested that the aortic annulus Z scores from the outflow tract views ranged widely and were not sensitive markers for tetralogy of Fallot.…”

“…12,18,19,26,27 Subsequent studies have investigated the roles of these views specifically in prenatal detection of tetralogy of Fallot. 20,21,28,29 Series of 1521, 2028, and 2520 fetuses with tetralogy of Fallot showed frequent abnormal vessel alignment in the 3-vessel or 3-vessel and trachea view, and the aortic arch isthmus typically measured larger than the ductus arteriosus. Our findings are in agreement with these series, demonstrating that the 3-vessel and trachea view, when visualized, was abnormal, with a reversed aortic arch isthmus-to-ductus arteriosus ratio in 100% of fetuses who were confirmed postnatally to have tetralogy of Fallot or a double-outlet right ventricle.…”

“…19 Subsequent articles have further explored the potential of the 3-vessel views to help in the identification of tetralogy of Fallot. 12,[20][21][22] However, these were largely small case series, and they did not address the performance of the 3-vessel and trachea view in comparison to the traditional detection method using the outflow tract view. In this study, we aimed to examine how often the 3-vessel and trachea view was abnormal in pregnancies complicated by tetralogy of Fallot and compare the detection rate with that approach to that of the outflow tract view.…”