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

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. (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. 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. 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. (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. 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. Atrial septal aneurysm at 32w1d: diminished left ventricular inflow. LV, left ventricle; RV, right ventricle (images from personal collection).

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. 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. 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. 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. 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).