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Updated: Apr 6, 2026
Morphological and Functional Assessment of the Right Ventricle Using 3D Echocardiography
Published on: October 28, 2020
Utility of a Single 3-Vessel View in the Evaluation of the Ventricular Outflow Tracts
Justin S Brandt1, Eileen Wang2, Jack Rychik2
1Maternal and Child Health Research Program, Department of Obstetrics and Gynecology, Center for Research on Reproduction and Women's Health, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania USA (J.S.B., E.W., N.S.); and Fetal Heart Program, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania USA (J.R., D.S., M.L.M.). justin.brandt@uphs.upenn.edu.
Insights
The 3-vessel view in fetal echocardiography effectively detects congenital heart disease, specifically outflow tract anomalies, with high sensitivity. This view can serve as a crucial first step in prenatal screening for cardiac defects.
Area of Science:
- Medical Imaging
- Cardiology
- Prenatal Diagnosis
Background:
- Congenital heart disease (CHD) diagnosis during pregnancy is vital for improving infant outcomes.
- Evaluating fetal ventricular outflow tracts is critical for diagnosing CHD.
- Conventional methods for assessing outflow tracts can be challenging.
Purpose of the Study:
- To assess the diagnostic utility of a single, isolated 3-vessel view image.
- To determine the effectiveness of the 3-vessel view in identifying ventricular outflow tract anomalies.
Main Methods:
- Prospective collection of 3-vessel view images from fetuses (18-23 weeks 6 days gestation).
- Two blinded observers evaluated images for normality or abnormality.
- Calculation of test characteristics for the isolated 3-vessel view.
Main Results:
- The 3-vessel view demonstrated 91% sensitivity for isolated outflow tract anomalies.
- Mean sensitivity for combined anomalies was 88%.
- All cases of Tetralogy of Fallot and Transposition of the Great Arteries were identified.
Conclusions:
- A single 3-vessel view image is a sensitive indicator of ventricular outflow tract anomalies.
- The 3-vessel view can be an effective initial view for evaluating outflow tracts in fetal echocardiography.
- This approach aids in the prenatal diagnosis of congenital heart disease.
Objectives:
Prenatal diagnosis of congenital heart disease can improve neonatal outcomes. The purpose of this study was to evaluate the utility of an isolated 3-vessel view image in evaluating the ventricular outflow tracts.
Methods:
Three-vessel view images were prospectively collected from consecutive patients referred to a regional fetal heart center for fetal echocardiography between gestational ages of 18 weeks and 23 weeks 6 days. Cardiac malformations were categorized as anomalies of the outflow tracts, the 4-chamber view, or combined lesions. A single representative still-frame 3-vessel view image was reviewed by 2 independent and blinded observers who were asked to label each image as "normal" or "abnormal." Test characteristics of the isolated 3-vessel view were calculated.
Results:
During the study period, 122 consecutive patients (139 fetuses) underwent fetal echocardiography. Eight fetuses with fetal chest anomalies and 12 fetuses with oblique images were excluded. Thirty-four of 119 fetuses (28.6%) had abnormal echocardiograms, including 11 outflow tract anomalies and 16 combined anomalies. Using the 3-vessel view alone, both reviewers achieved 91% sensitivity for the detection of isolated outflow tract anomalies and mean sensitivity of 88% for combined anomalies. All cases of tetralogy of Fallot and transposition of the great arteries were identified in the 3-vessel view.
Conclusions:
A single 3-vessel view image can serve as a representative view of the outflow tracts and can show ventricular outflow tract anomalies with high sensitivity. Given that the conventional outflow tract views can be difficult to obtain, the 3-vessel view may serve as an effective first-line view when evaluating the ventricular outflow tracts for congenital heart disease.
