TheNormal3VVand3VTviewandcommonabnormalities

DrVictoriaJowettConsultantFetalCardiologistGreatOrmondStreetHospital

FetalCardiologyforObstetriciansandFetalMedicineSpecialists,23rdJanuary2020

3VTview

• Whatisthe3VTview?

• Whatarewelookingfor?

• Whatcanwepickupin

thisview?

3Vesselandtrachealview

Aorticandductalarchesinthefetus

Whyisthisviewimportant?Ductdependentlesions

15%ofCHD.

• Ductdependentsystemiccirculation

• Ductdependentpulmonarycirculation

Neonatalcollapse

Morbidityandmortality

withductalclosure.

www.ctsnet.org

Manyductdependentlesionsaredetectableon3VTview

• Coarctationoftheaorta• CriticalAorticStenosis• CriticalPulmonaryStenosis• Pulmonaryatresia• HLH• Interruptedaorticarch• TGA

Introductionof3VTviewUKfetalanomalyscreeningprogramme

Increaseddetectionofrightanddoubleaorticarch

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80

2015 2016 2017 2018

Double aortic arch

Right aortic arch

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2010 2011 2012 2013 2014 2015 2016 2017 2018

Antenatal diagnoses

NICOR

Detectingabnormalityinthethreevesselandtrachealview

1.Abnormalvesselnumber

2.Abnormalvesselposition• Arrangement(leftright)• Position(anterior/posterior)• Direction(passingtrachea)

3.Abnormalvesselsize PA>AO>SVC

4.Abnormaldirectionofflow

ANTERIOR

POSTERIOR

R

L SVC

AODUCT

Howmanyvessels2,3,4…

2VesselsSeen

Actuallyonly2vessels• Truncus• PATVSD

Impressionofonly2vesselsduetoabnormalarrangementegTGA

3VesselsSeen

Normal?

Checkorderofvessels

Left

SAD

Right

4VesselsSeen

• Left SVC • (0.3% adult population)

• AscendingVeinTAPVC

AbnormalPositionofVessels

• AbnormalAlignmentDisruptionofthenormallefttorightlineararrangementofthearteries

Disturbanceofanteriorposteriorarrangementofthearteries

Examples• TetralogyofFallot–dilatedaortadisplacedanteriorly• HLH/IAA-Aortamaybeposteriorlydisplaced• TGA–aortaanteriorandrightward• Rightaorticarch–aortatorightoftrachea

Normal/TetralogyofFallot

TGAandCCTGA

• TGA• Aortarightanterior

• CCTGA

ImportanceofIdentifyingRAA

• Identify other abnormalities • Increased risk of chromosomal abnormalities • Potential for vascular ring

(ALSCA)

D’AntonioetalUOG2016

Doubleaorticarch

Right

Left

Abnormalitiesofsize

HypoplasticvesselAorta<PA(CoarctationHLH,AS)PA<Aorta(TOF,PS,PAT)

DilatedvesselAorta(AS,Aortopathy)Pulmonaryartery(PS)SVC(Azygous/TAPVC/ECA)

Coarctationoftheaorta

ExcellentSurgicalOutcome4-6%ofCHD

WhatdoescolourDoppleradd?

Summary3VTviewImportantcluestoductdependentlesions

Numberofvessels Sizeofvessels Positionof

vesselsDirectionofcolourflow