Post on 13-Oct-2020
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
0
10
20
30
40
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60
70
80
2015 2016 2017 2018
Double aortic arch
Right aortic arch
0
10
20
30
40
50
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80
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