Viñals F, Heredia F, Giuliano A
Centro AGB Ultrasonografía, Ultrasound Department, Clínica Sanatorio Alemán, Concepción, Chile.
Ultrasound Obstet Gynecol. 2003 Oct;22(4):358-67. doi: 10.1002/uog.882.
To analyse the anomalies seen at the three vessels and trachea (3VT) view in fetuses with antenatally diagnosed congenital heart disease (CHD), specifically in defects involving the upper mediastinum, including the outflow tracts and/or arteries.
Seventy-four consecutive fetuses of singleton pregnancies with antenatally diagnosed structural heart defects were initially included in the study. We selected those in which there was an anomaly seen on the 3VT view and classified them into groups: abnormalities detected on the upper mediastinum (abnormal vessel size, alignment, arrangement and number), abnormal location of the transverse aortic arch in relation to the trachea, and abnormal functional behavior of the arterial vessels (reversed flow and turbulent flow) detected using color Doppler. The abnormalities detected were confirmed postnatally by a pediatric cardiologist, echocardiography and/or autopsy.
Thirty-four of the 74 fetuses showed an abnormal 3VT view that could be classified into one of the groups. We classified the lesions according to the most evident abnormal finding during the examination. Gestational age ranged from 17 to 39 (mean, 30) weeks. Abnormal vessel size was found in 20 of the 74 fetuses, abnormal vessel alignment was found in two fetuses, and abnormal vessel arrangement in three fetuses. Two vessels instead of three were found in five fetuses and four vessels were found in two fetuses. Abnormal visualization of the trachea, between the pulmonary artery and the transverse arch, occurred in one fetus with isolated right aortic arch. We found reversed flow in the transverse aortic arch in three fetuses with aortic atresia and in two fetuses with severe coarctation of the aorta. Reversed flow in the pulmonary trunk was seen in a fetus with pulmonary atresia and double outlet right ventricle. Turbulent flow was found in two fetuses with outflow tract stenosis.
Our study, descriptive in nature, demonstrates that the 3VT view is a reliable method with which to determine abnormalities in the upper mediastinum. It proved to be efficient in identifying an important group of critical heart defects involving the outflow tracts and the aortic arch. It also provided important clues to the diagnosis of minor anomalies considered as markers of other CHD. We believe that use of the 3VT view should become routine in screening for CHD.
分析产前诊断为先天性心脏病（CHD）的胎儿在三血管和气管（3VT）视图中所见的异常情况，特别是涉及上纵隔的缺陷，包括流出道和/或动脉。
本研究最初纳入了74例单胎妊娠且产前诊断为结构性心脏缺陷的胎儿。我们选择了那些在3VT视图中可见异常的胎儿，并将其分为几组：在上纵隔检测到的异常（血管大小、排列、布局和数量异常）、横位主动脉弓相对于气管的位置异常，以及使用彩色多普勒检测到的动脉血管功能异常（反向血流和湍流）。检测到的异常在出生后由儿科心脏病专家、超声心动图和/或尸检证实。
74例胎儿中有34例显示3VT视图异常，可分为其中一组。我们根据检查期间最明显的异常发现对病变进行分类。孕周范围为17至39（平均30）周。74例胎儿中有20例发现血管大小异常，2例胎儿发现血管排列异常，3例胎儿发现血管布局异常。5例胎儿发现两根血管而非三根血管，2例胎儿发现四根血管。在1例孤立性右位主动脉弓胎儿中，肺动脉和横位主动脉弓之间的气管可视化异常。在3例主动脉闭锁胎儿和2例严重主动脉缩窄胎儿的横位主动脉弓中发现反向血流。在1例肺动脉闭锁和右心室双出口胎儿的肺动脉主干中发现反向血流。在2例流出道狭窄胎儿中发现湍流。
我们的研究本质上是描述性的，表明3VT视图是确定上纵隔异常的可靠方法。它被证明在识别涉及流出道和主动脉弓的一组重要的严重心脏缺陷方面是有效的。它还为诊断被视为其他CHD标志物的轻微异常提供了重要线索。我们认为，3VT视图的使用应成为CHD筛查的常规操作。
