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The three vessels and trachea view (3VT) in fetal cardiac scanning
1Department of Obstetrics and Gynecology, Hadassah University Hospital, Mt Scopus, Jerusalem, Israel. syagel@hadassah.org.il
Insights
The three vessels and trachea (3VT) view is a novel, efficient method for examining fetal mediastinal vessels. This technique simplifies identifying the aortic arch in fetal echocardiography, proving more effective than traditional methods.
Area of Science:
- Medical imaging
- Fetal medicine
- Cardiology
Background:
- Fetal heart evaluation is crucial for detecting malformations.
- Examining mediastinal major vessels is challenging and time-consuming.
- A simpler method for great vessel assessment is needed.
Purpose of the Study:
- To define and evaluate the three vessels and trachea (3VT) view for fetal echocardiography.
- To establish nomograms for cardiac vessel measurements using the 3VT view.
- To assess the clinical applicability and efficiency of the 3VT view.
Main Methods:
- The 3VT view was examined in 379 low-risk pregnancies (14-24 weeks gestation).
- Six parameters were measured to create nomograms.
- The time to identify the aortic arch using 3VT vs. long-axis view was compared in 984 patients.
Main Results:
- The 3VT view was successfully obtained in 1361 out of 1363 cases.
- Identifying the aortic arch with 3VT took <10 minutes in 96.5% of cases (17/982).
- The long-axis view required >10 minutes for aortic arch identification in 71 patients (P < 0.001).
Conclusions:
- The 3VT view is clinically applicable for evaluating mediastinal major vessels.
- While individual parameter variations limit anomaly diagnosis, ratios show potential.
- The 3VT view is more efficient for aortic arch identification than the long-axis view.
Objective:
Comprehensive evaluation of the fetal heart has become a major part of targeted organ scanning to rule out fetal malformations. Evaluation of the mediastinal major vessels seems to be the most difficult and time-consuming part of fetal heart examination. Our aim was to define and evaluate the three vessels and trachea (3VT) view, a novel and simple method to examine the great vessels in the mediastinum, and its applicability in the clinical practice of fetal echocardiography, while establishing nomograms for cardiac vessel measurements obtained in this view.
Methods:
The three vessels and trachea view was examined in 379 low-risk gravidae between 14+0 and 23+6 weeks' gestation. Six parameters in this plane were measured to establish nomograms. In another group of 984 mixed high- and low-risk patients we compared the time required to identify the aortic arch using the 3VT view as compared to the long-axis view.
Results:
The 3VT view was readily and satisfactorily demonstrated in all but two of the 1363 cases examined. In 17 cases (out of a total of 982) more than 10 min were required to identify the aortic arch using the 3VT view and in 71 patients when employing the long-axis view (P < 0.001).
Conclusion:
The clinical applicability of the 3VT view to evaluate the anatomy of the major vessels in the mediastinum is demonstrated. Although a wide variation in the six parameters of the 3VT view used here precludes their use in diagnosing great vessel anomalies, some of the ratios between them have promising potential in the evaluation of great vessel malformations. Further, the 3VT view seems to be more efficient in identifying the aortic arch than does the long-axis view.