1105: Extended use of three-vessel view at fetal echocardiography

Abstract

Three-vessel view is an orthogonal transverse view of the upper mediastinum in which the main pulmonary artery, ascending aorta and superior vena cava are aligned in a straight line from the left anterior to the right posterior part of the thorax with a decreasing order of the size. Its utility in the diagnosis of the malformations involving the ventricular outflow tracts and great arteries have well been documented and it is used as a standard view of the fetal cardiac screening in many centers. The clues to the abnormalities discussed in the previous studies by us and others included; (1) abnormal vessel size, (2) abnormal vessel arrangement, (3) abnormal vessel alignment, (4) presence of only two vessels and (5) presence of an additional vessel. In the present presentation we discuss extended utilization of three-vessel view. With a little upward and downward sweeping of the transducer from the standard three-vessel plane, one may evaluate the right and left pulmonary arterial origins and the axial view of the aortic arch and its branching. Airway also can also be imaged as it is filled with amniotic fluid. In addition, the thymus can be seen as a rectangular structure in the anterior mediastinum along the anterior and lateral margins of the three vessels. Since our initial reports, we and others have found that the three-vessel view is also useful in the evaluation of (1) the aortic arch position relative to the trachea, (2) the presence or absence of the aberrant arterial branch arising from the aorta, (3) the abnormalities of the pulmonary arterial branching, (4) the supracardiac types of anomalous pulmonary venous connections, (5) the positional abnormality of the atrial appendages, i.e., juxtaposition of the atrial appendages and (6) the status of the thymus when microdeletion of the chromosome 22q are suspected. Three-vessel view is an orthogonal transverse view of the upper mediastinum in which the main pulmonary artery, ascending aorta and superior vena cava are aligned in a straight line from the left anterior to the right posterior part of the thorax with a decreasing order of the size. Its utility in the diagnosis of the malformations involving the ventricular outflow tracts and great arteries have well been documented and it is used as a standard view of the fetal cardiac screening in many centers. The clues to the abnormalities discussed in the previous studies by us and others included; (1) abnormal vessel size, (2) abnormal vessel arrangement, (3) abnormal vessel alignment, (4) presence of only two vessels and (5) presence of an additional vessel. In the present presentation we discuss extended utilization of three-vessel view. With a little upward and downward sweeping of the transducer from the standard three-vessel plane, one may evaluate the right and left pulmonary arterial origins and the axial view of the aortic arch and its branching. Airway also can also be imaged as it is filled with amniotic fluid. In addition, the thymus can be seen as a rectangular structure in the anterior mediastinum along the anterior and lateral margins of the three vessels. Since our initial reports, we and others have found that the three-vessel view is also useful in the evaluation of (1) the aortic arch position relative to the trachea, (2) the presence or absence of the aberrant arterial branch arising from the aorta, (3) the abnormalities of the pulmonary arterial branching, (4) the supracardiac types of anomalous pulmonary venous connections, (5) the positional abnormality of the atrial appendages, i.e., juxtaposition of the atrial appendages and (6) the status of the thymus when microdeletion of the chromosome 22q are suspected.