Three‐vessel view of the fetal upper mediastinum: an easy means of detecting abnormalities of the ventricular outflow tracts and great arteries during obstetric screening

Abstract

The three-vessel view is a transverse view of the fetal upper mediastinum is as simple to obtain as the four-chamber view. It demonstrates the main pulmonary artery, ascending aorta and superior vena cava in cross- or oblique sections. The purposes of this study were to describe the normal anatomy of the three-vessel view and to analyze what anatomical changes would occur in this view when there are lesions of the ventricular outflow tracts and/or great arteries. Sonograms of 29 fetuses with lesions involving the ventricular outflow tracts and/or great arteries were reviewed. Three-vessel views were evaluated in terms of vessel size, number, arrangement and alignment. Twenty-eight of 29 fetuses showed an abnormal three-vessel view that included abnormal vessel size (n = 12), abnormal alignment (n = 8), abnormal arrangement (n = 7) and abnormal vessel number (n = 3). The vessel size was abnormal in obstructive lesions of the right (n = 4) or the left (n = 8) side of the heart. An abnormal alignment was seen in tetralogy of Fallot (n = 6) and double-outlet right ventricle (n = 2) that showed anterior displacement of the aorta. An abnormal arrangement was seen in complete (n = 4) and corrected (n = 1) transposition, double-outlet right ventricle (n = 1) and pulmonary atresia with ventricular septal defect (n = 1). Only two vessels were seen in truncus arteriosus (n = 1). Four vessels were seen in persistent left superior vena cava (n = 2). A fetus with pulmonary atresia and intact ventricular septum showed a normal three-vessel view. In conclusion, most of the lesions involving the ventricular outflow tracts and/or great arteries showed an abnormal three-vessel view.

Anomalies of the fetal aortic arch: a novel sonographic approach to in‐utero diagnosis

“…In our study, all cases with right aortic or double arches showed an abnormal axial, upper, mediastinal view with U-shaped intermediate trachea. Although a similar upper-mediastinal view has been recently described 13 , and even suggested to be incorporated in a sequential segmental approach to fetal congenital heart disease 14 , no indication for tracheal identification or linkage with aortic arch anomalies has been mentioned. We therefore recommend that the trachea be added as a landmark in evaluation of the aortic arch while performing fetal cardiac examination.…”

Four-dimensional fetal echocardiography with spatiotemporal image correlation (STIC): A systematic study of standard cardiac views assessed by different observers

“…However, the diagnostic accuracy for prenatal diagnosis of congenital heart disease is limited . Reasons for the low detection rates include: (1) inadequate examination; (2) anomalies not present at the time of routine ultrasound scan (e.g., valvular disorders may evolve during pregnancy); and (3) incomplete evaluation of the outflow tracts [9,10,[37][38][39][40][41][42][43][44].…”

Persistent left superior vena cava – considerations in fetal, pediatric and adult populations

“…An isolated enlarged coronary sinus (Figure 5) is highly suggestive of persistent LSVC, although this finding may have both false positive and false negative diagnoses 3 28 – 35 …”