Three-vessel view of the fetal heart: In utero development of the great vessels

Unfavorable postnatal outcome with significant dilation of the fetal main pulmonary artery near term

INTRODUCTION

Fetal echocardiography in third trimester is relatively rare reported and there is no data, what is the clinical meaning of the main pulmonary artery (MPA) dilatation in third trimester or before the delivery in fetuses with congenital heart defect. We analyzed the neonatal follow-up in cases of significantly dilated MPA diameter to better understand its clinical significance.

MATERIAL AND METHODS

Retrospectively 238 healthy singleton fetuses were selected as a reference group. Consecutive percentiles for MPA diameter according to the gestational age were calculated. In second step, we selected cases whose MPA diameter measured at the level of three vessel trachea view (3VT view) was pointedly above 95th centile in third trimester of pregnancy, according to the obtained data of our healthy population.

RESULTS

There were 11 fetuses, with dilated MPA diameter (range 12-13.5 mm), who had last echocardiography performed at 37.6 weeks of gestation. There were 11 isolated heart defects: 7 cases with HLHS, 2 with d-TGA, and 2 cases with CoA. Mean neonatal weight was 3,345 g, with Apgar score 8-10. About 10 newborns out of 11 had cardiac surgery at the mean 12th day of the postnatal life and 8 of them died on the mean 23rd day. Autopsy was performed in 5 cases. In all of them histopathology reports described pulmonary hypertension in addition to cardiac structural abnormalities.

CONCLUSION

Severe dilation of the fetal MPA before the delivery suggested prenatal abnormal lung development and was a poor prognostic factor. In these cases postnatal pulmonary hypertension should be suspected.

Fetal aorta larger than the main pulmonary artery on the three-vessel view: Correlation with postnatal echocardiographic findings

PURPOSE

This study investigated postnatal cardiac anomalies determined by postnatal echocardiography in fetuses with the ascending aorta (AA) diameter larger than that of the main pulmonary artery (MPA) on the three-vessel view (3VV).

METHODS

The study included 17 pregnancies. The diameters of the AA and MPA were assessed on the 3VV in second-trimester sonographic screening, and all the patients underwent postnatal echocardiography to assess the cardiac outcome.

RESULTS

In the study population, the mean AA diameter was 3.7 mm (range, 2.2-5.6 mm), and the mean MPA diameter was 3.2 mm (range, 1.8-5.2 mm). The mean AA/MPA ratio was 1.2 (range, 1.1-1.9). According to the postnatal echocardiograms, one of the patients had tetralogy of Fallot. This patient had the highest prenatal AA/MPA ratio (1.9). Among the remaining 16 cases, five had secundum atrial septal defects, with two having concomitant dilatation of the AA. There was one case of isolated dilatation of the AA.

CONCLUSIONS

Although an AA with a diameter larger than that of the MPA on the 3VV does not usually indicate severe congenital heart disease involving the ventricular outflow tract and/or great arteries, careful prenatal and postnatal echocardiographic examinations are mandatory to determine the presence of congenital heart disease. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 44:423-428, 2016.

Development of the abdominal aorta and iliac arteries during the fetal period: a morphometric study

PURPOSE

This study aimed to determine the location and morphometric development of the fetal abdominal aorta and the iliac arteries.

METHODS

The study was carried out between 1996 and 2008 on 172 spontaneously aborted human fetuses (76 males and 96 females) aged between 9 and 40 weeks. None of the fetuses had any external pathology or anomaly. The location of the abdominal aorta was determined in reference to the vertebral column. This was followed by measurements of the lengths, external diameters of the origin of the aorta, and bifurcation of aorta as well as the bifurcation angles of the abdominal aorta. The vertebral levels at which the abdominal aorta started and bifurcated were determined. The lengths and external diameters of the common iliac arteries, diameters of the internal and external iliac arteries, and lengths of the external iliac arteries were measured. The vertebral levels of bifurcation of the common iliac arteries were determined.

RESULTS

The fetal abdominal aorta lay in the midline, in front of the vertebral column. The mean bifurcation angle of the abdominal aorta was greater than adults in the third trimester and at full term. The lengths and diameters of the abdominal aorta and the iliac arteries increased with gestational age, and significant positive correlations were found. There were no sex or laterality differences in either parameter. External diameter of the internal iliac artery was larger than that of the external iliac artery. Bifurcation of the abdominal aorta to the common iliac arteries was more inferior compared to the adults, and these levels rose with gestational age.

CONCLUSION

The morphometric parameters and location of the fetal abdominal aorta and the iliac arteries were determined by the present study. We conclude that the abdominal aorta lay in the midsagittal plane. The bifurcation level of the abdominal aorta arose with gestational age and at full term, and reaches to the same level as adults. In the early fetal period, the bifurcation level of the common iliac artery was more inferior compared to the adults, and they reach the adult positions around full term. The diameter of the internal iliac artery was nearly one and a half times larger than the external iliac artery. The findings of this study would be present, detailed information about the development of the abdominal aorta and the iliac arteries; this will also contribute to radiological (ultrasound and MR) studies in the intrauterine period.

Aorta larger than pulmonary artery in the fetal 3-vessel view

OBJECTIVE

Fetal great artery asymmetry may accompany congenital heart disease. The fetal echocardiographic 3-vessel view (3VV) allows assessment of the superior vena cava, ascending aorta (AA), and main pulmonary artery (MPA). Our aim was to determine the association of congenital heart disease in fetuses with an AA/MPA ratio of greater than 1.

METHODS

We electronically searched our fetal echocardiographic database for studies performed between March 2002 and January 2008 that showed 3VVs with AA/MPA ratios of greater than 1 and correlated the findings with the presence of congenital heart disease.

RESULTS

In 2797 fetal echocardiograms, we identified 31 fetuses with normal 4-chamber views showing AA/MPA ratios of greater than 1 in the 3VV. Of 31 fetuses, 25 (81%) had tetralogy of Fallot (ToF) or a ToF variant, and 6 (19%) had an aortic valve abnormality or isolated dilatation of the AA.

CONCLUSIONS

Screening obstetric fetal sonography showing a 3VV AA/MPA ratio of greater than 1 suggests congenital heart disease and indicates the need for comprehensive fetal echocardiography.