Diagnosis of fetal ductus arteriosus aneurysm: importance of the three‐vessel view

• Published in: Ultrasound in obstetrics & gynecology 2005-07, Vol.26 (1), p.57-62
• Main Authors: Jackson, C. M., Sandor, G. G. S., Lim, K., Duncan, W. J., Potts, J. E.
• Format: Article
• Language: English
• Subjects: Adult; aneurysm; Aneurysm - diagnostic imaging; Aorta - diagnostic imaging; Biological and medical sciences; Blood Grouping and Crossmatching; Cardiology. Vascular system; Congenital heart diseases. Malformations of the aorta, pulmonary vessels and vena cava; Diabetes, Gestational - diagnostic imaging; ductus arteriosus; Ductus Arteriosus - diagnostic imaging; Echocardiography - methods; Female; Gynecology. Andrology. Obstetrics; Heart; Humans; Hydrops Fetalis - diagnostic imaging; Lupus Erythematosus, Systemic - diagnostic imaging; Medical sciences; Pregnancy; Pregnancy Outcome; Pulmonary Artery - diagnostic imaging; three‐vessel view; Ultrasonography, Prenatal - methods; Vena Cava, Superior - diagnostic imaging
• ISSN: 0960-7692; 1469-0705
• DOI: 10.1002/uog.1927

Objective To present four cases of ductus arteriosus aneurysm (DAA) detected by fetal echocardiography and highlight the value of the three‐vessel view in the diagnosis of DAA. Methods In addition to the standard fetal echocardiographic views, we examined the three‐vessel view in four cases of DAA. The three‐vessel view was achieved by sliding the transducer cranially from the four‐chamber plane toward the fetal upper mediastinum to demonstrate cross‐sections of the main pulmonary artery, the ascending aorta and superior vena cava arranged in a straight line from the left anterior to the right posterior aspect of the mediastinum. DAA was diagnosed when there was a tortuous ductus arteriosus with a dilation that protruded leftward of the aortic arch. Case series In the first case, an insulin‐dependent diabetic woman underwent fetal ultrasound examination at 36 weeks' gestation showing right‐to‐left cardiac disproportion and bidirectional flow in the aorta and main pulmonary artery (PA). The three‐vessel view showed a dilated ductus arteriosus (DA) which was stenosed at its distal end. In the second case, a woman had fetal ultrasound scans at 38 and 39 weeks' gestation for suspected intrauterine growth restriction and oligohydramnios. The scans identified an abnormal aortic arch and the three‐vessel view showed an elongated vascular structure at the distal end of the PA, which was the DAA. In the third case, a woman with a high‐risk obstetric history had multiple scans showing an abnormal PA to aorta relationship, with an apparent ‘kink’ in the PA. The three‐vessel view clarified that this was the DAA. In the fourth case, a woman was scanned because of a 3‐kg weight gain in 1 week. The fetal ultrasound scan showed moderate polyhydramnios with normal fetal growth and normal intracardiac anatomy and flow, and the three‐vessel view demonstrated a large DA. In each of these cases, the DAA appeared to have occurred in isolation with non‐specific clinical findings. Conclusion We advocate the use of the three‐vessel view, in conjunction with the standard echocardiography views currently employed, to assist in the diagnosis of DAA. Copyright © 2005 ISUOG. Published by John Wiley & Sons, Ltd.