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#Grand Rounds

How Well Does the Prenatal Ultrasound ‘Three-Vessel View’ Work for Increasing the Detection of Cardiac Anomalies?

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BACKGROUND AND PURPOSE:

  • Transposition of the great arteries (TGA) and tetralogy of Fallot (ToF) are serious cardiac anomalies but both can often have normal 4 chamber views
  • Everwijn et al. (Obstetrics & Gynecology, 2018) analyzed the annual detection rate (DR) for TGA and ToF after the introduction of the three‐vessel view (3VV) as a mandatory plane in 2012

METHODS:

  • Retrospective cohort study
  • Data on TGA and ToF cases between 2007-2016 were extracted
  • The DR in a 10 year period before 2011 was compared with the DR of TGA and ToF after 2012

RESULTS:

  • TGA cases detected prenatally significantly increased with 3VV (P≤0.001)
    • 10 years prior to 2012: 44.2%
    • After 2012: 82.4%
  • ToF cases detected prenatally significantly increased with 3VV (P≤0.05)
    • 10 years prior to 2012: 43.8%
    • After 2012: 67.7%
  • Mortality rates <1
    • Did not significantly decrease for both TGA and ToF
      • ToF: Not duct dependent in most cases
      • TGA: Relatively high mortality >2012 due to one death in the detected group due to abnormal coronary artery anatomy plus deaths in the undetected group

CONCLUSION:

  • A prenatal screening program that includes 3VV can significantly contribute to early detection of TGA and ToF
  • Absence of reduced mortality may be a result of small numbers and decreased power
  • Other benefits include ability to diagnose and prepare for 22q deletion syndrome that is strongly associated with ToF

Learn More – Primary Sources:

The effect of the introduction of the three‐vessel view on the detection rate of transposition of the great arteries and tetralogy of Fallot

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Related ObG Topics:

Practical obstetrics info for your women's healthcare practice
Tetralogy of Fallot- A Critical Congenital Heart Defect
Practical obstetrics info for your women's healthcare practice
Understanding Transposition of the Great Arteries
22q11.2 Deletion Syndrome – Key Clinical Highlights
Is Prenatal Microarray Use Justified as a First Tier Test for Fetal Congenital Heart Disease?
Chromosomal Microarray Analysis for Congenital Heart Disease – Clinically Relevant Findings

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