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© 2008 by the American Institute of Ultrasound in Medicine
J Ultrasound Med 27:1617-1622 • 0278-4297

Technical Advance

Use of the 3-Vessel View to Record Doppler Velocity Waveforms From the Aortic Isthmus in Normally Grown and Growth-Restricted Fetuses

Comparison With the Long Aortic Arch View

Giuseppe Rizzo, MD, Alessandra Capponi, MD, Marianne Vendola, MD, Maria Elena Pietrolucci, MD and Domenico Arduini, MD

Department of Obstetrics and Gynecology, University of Rome Tor Vergata (G.R., M.V., M.E.P., D.A.), Rome, Italy; and Department of Obstetrics and Gynecology, G. B. Grassi Hospital, Rome, Italy (A.C.).

Address correspondence to Giuseppe Rizzo, MD, Department of Obstetrics and Gynecology, University of Rome Tor Vergata, Fatebenefratelli San Giovanni Calabita Hospital, Isola Tiberina 89, 00186 Rome, Italy. E-mail: giuseppe.rizzo{at}uniroma2.it

Objective. Aortic isthmus (AoI) velocity waveforms are considered powerful indicators of hemodynamic deterioration in intrauterine growth-restricted (IUGR) fetuses. However, technical difficulties in sampling AoI velocity waveforms from the longitudinal aortic arch (LAA) have limited its clinical application thus far. In this study, we tested the possibility of recording AoI velocity waveforms from the 3-vessel (3V) view of the fetal mediastinum and comparing the agreement of these measurements with recordings from the LAA. Methods. Doppler measurements of the pulsatility index (PI) from the AoI were performed in 70 fetuses (20 IUGR and 50 normally grown) between 20 and 34 weeks’ gestation. All measurements were sampled in both the LAA and 3V views by the same investigator. Reliability was evaluated with intraclass correlation coefficients (ICCs), and Bland-Altman plots were generated. The time required to complete the measurements was compared. Results. A high degree of reliability was observed between PI values obtained from LAA and 3V views in both IUGR and normally grown fetuses (all fetuses: ICC, 0.976; 95% confidence interval [CI], 0.961–0.985; normally grown: ICC, 0.839; 95% CI, 0.731–0.906; IUGR: ICC, 0.954; 95% CI, 0.886–0.982). However, recordings from the 3V view were significantly less time-consuming than those from the LLA view (mean ± SD, 30.4 ± 14.2 versus 52.8 ± 29.4 seconds; P < .0001) and showed higher intraobserver reproducibility. Conclusions. In IUGR and normally grown fetuses, AoI waveforms can be reliably obtained from the 3V view with higher reproducibility and a shorter recording time.

Key Words: Doppler sonography • fetal aortic isthmus • intrauterine growth restriction • 3-vessel view

Abbreviations: AoI, aortic isthmus • CI, confidence interval • ICC, intra-class correlation coefficient • IUGR, intrauterine growth-restricted • LAA, longitudinal aortic arch • PI, pulsatility index • 3V, 3-vessel • UA, umbilical artery

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Copyright © 2008 by the American Institute of Ultrasound in Medicine.