Apparent normal arrangement pattern of three-vessel view in a fetus with transposition of great arteries and L-malposed aorta

Abstract

Transposition of great arteries (TGA) is more commonly associated with D-malposition of great arteries where anterior aorta produces characteristic “I” sign in the three-vessel view (3VV) in fetal heart imaging. We describe two cases with TGA and L-malposition of aorta where 3VV imaging showed an apparently normal arrangement of vessels while outflow tract imaging proved vital in diagnosing transposition anatomy. Apparently, normal 3VV in the presence of disproportionate vessel caliber and inability to produce normal outflow images should raise the suspicion. Attempts should be made to produce views to show great arteries originating from respective ventricles to rule out ventriculoarterial discordance and to complete segmental analysis.

A tricky fetal case of isolated transposition of great arteries without the I‐shaped sign

“…However, it is important to note that the I‐sign is not present in rare cases of isolated TGA in which the great vessels are in the side‐by‐side position, similar to the present case. Cases of fetal TGA with this rare vessel pattern were previously reported by Verma et al 4 They described two fetal cases of TGA and L‐malposition of the aorta in which the three‐vessel view showed an apparently normal arrangement of vessels. Since both pregnancies were discontinued, it was not possible to assess the usefulness of the fetal diagnosis for the prognosis after birth.…”