© 2009 by the American Institute of Ultrasound in Medicine

J Ultrasound Med 2009; 28:9–12



Aorta Larger Than Pulmonary Artery in the Fetal 3-Vessel View



Robert C Rollins, MD, Ruben J Acherman, MD, William J Castillo, MD, William N Evans, MD,

Humberto Restrepo, MD, MPH



ChildrenŐs Heart Center Nevada, 3006 S Maryland Pkwy, Ste 690, Las Vegas, NV 89109, USA.

Email: rollins@childrensheartcenter.com.



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.


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