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. 2022 Feb 10;58(2):262.
doi: 10.3390/medicina58020262.

The Additional Role of the 3-Vessels and Trachea View in Screening for Congenital Heart Disease

Roxana Gireadă  1 , Demetra Socolov  1   2 , Elena Mihălceanu  1   2 , Roxana Matasariu  1   2 , Alexandra Ursache  1 , Mona Akad  1 , Iuliana Bujor  1 , Ioana Scripcariu  1   2 , Radu Florin Popa  1 , Răzvan Socolov  1   3
Affiliations

The Additional Role of the 3-Vessels and Trachea View in Screening for Congenital Heart Disease

Roxana Gireadă et al. Medicina (Kaunas). .

Abstract

Background and Objectives: Although frequent and associated with high mortality and morbidity rate, congenital heart disease (CHD) has a suboptimal prenatal detection rate, with significant variation according to the scanning protocol. The aim of this study was to evaluate the role of the 3-vessels and trachea view (3VT) in detecting CHD, with or without the use of Color Doppler, with an emphasis on major CHD. Materials and Methods: We performed a retrospective study on 1596 unselected pregnant patients presenting at 11-37 weeks of gestation for a routine anomaly scan. We selected all CHD cases, and we analyzed the performance of the 4-chamber (4C) and 3VT view in detecting CHD. Results: A total of 46 fetuses with CHD were identified, yielding a 2.86% overall incidence, and 0.87% for major CHD. Grayscale 4C detected 47.8% of all CHD, going up to 71.7% by adding grayscale 3VT, with no major CHD remaining undetected by combining grayscale 4C and 3VT. Conclusions: Grayscale 4C and 3VT views are effective in detecting major CHD, thus proving their utility even in a low resource setting.

Keywords: 3-vessels and trachea view; congenital heart disease; prenatal screening.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Scheme 1
Scheme 1
Flowchart clarifying the selection of study population. 1 Excluded CHD: cardiac rhythm disorders, persistent right umbilical vein, and umbilical vein varix. 2 Hygroma-associated CHD with early TOP was excluded from major CHD definition (n = 3). 3 General physical exam, heart auscultation, and preductal and postductal pulse oximetry. CHD, congenital heart disease; DC DA, dichorionic diamniotic twins; MC DA, monochorionic diamniotic twins; TOP, termination of pregnancy; IUFD, intrauterine fetal demise; TTE, transthoracic echocardiography; 4C, four chamber view; and 3VT, 3-vessels and trachea view.
Figure 1
Figure 1
(a) D-transposition with normal 4C view; (b) Only two vessels (the aorta and the right superior vena cava) are seen on grayscale 3VT. Ao, aorta; RSVC, right superior vena cava; Tr, trachea (images from personal collection).
Figure 2
Figure 2
Abnormal 3VT in a case of interrupted aortic arch type B with associated malalignment VSD. RSVC, right superior vena cava; Tr, trachea; IAoA, interrupted aortic arch; PA, pulmonary artery (images from personal collection).
Figure 3
Figure 3
Abnormal 3VT in a case of tetralogy of Fallot: there is a large aorta, and the pulmonary artery cannot be identified. Ao, aorta; RSVC, right superior vena cava; Tr, trachea (images from personal collection).
Figure 4
Figure 4
(a) Grayscale 3VT: the transverse aorta narrows gradually and is difficult to follow up to the ductus arteriosus; (b) Color 3VT: the aortopulmonary convergence appears normal, with great vessels seemingly having the same caliber. PA, pulmonary artery; Ao, aorta; RSCV, right superior vena cava; Tr, trachea (images from personal collection).
Figure 5
Figure 5
Atrial septal aneurysm at 32w1d: the transverse aortic arch is smaller than the pulmonary artery on 3VT, but with anterograde flow. Ao, aorta, Tr, trachea; RSVC, right superior vena cava; PA, pulmonary artery (images from personal collection).
Figure 6
Figure 6
Atrial septal aneurysm at 32w1d: diminished left ventricular inflow. LV, left ventricle; RV, right ventricle (images from personal collection).
Figure 7
Figure 7
Mild pulmonary stenosis stable in the 3rd trimester: enlarged pulmonary artery with turbulent flow. PA, pulmonary artery; Ao, aorta; RSVC, right superior vena cava; Tr, trachea (images from personal collection).
Figure 8
Figure 8
The ductus arteriosus forms a tortuous loop, which is evident on grayscale 3VT. DAA, ductus arteriosus aneurysm; PA, pulmonary artery; Ao, aorta (images from personal collection).
Figure 9
Figure 9
Right aortic arch with left ductus arteriosus showing its typical U shape on color 3VT (a) First trimester; (b) Second trimester. PA, pulmonary artery; Ao, aorta; Tr, trachea (images from personal collection).
Figure 10
Figure 10
Aberrant right subclavian artery coursing behind the trachea at 20w0d. ARSA, aberrant right subclavian artery; Tr, trachea; RSVC, right superior vena cava; Ao, aorta; PA, pulmonary artery (images from personal collection).
Figure 11
Figure 11
Persistent left superior vena cava is identified as a fourth vessel on the 3VT view, seen on the left side of the pulmonary artery. RSVC, right superior vena cava; Tr, trachea; LSVC, left superior vena cava; Ao, aorta; PA pulmonary artery (images from personal collection).
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