Grand Rounds

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

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

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

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

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

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