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Application of the 3-Vessel View in Routine Prenatal Sonographic Screening for Congenital Heart Disease

Ultrasound Center, Beijing Obstetrics and Gynecology Hospital (Q.W., W.Z.), and School of Public Health and Family Medicine (M.L., L.J., X.Y., Y.Y., W.W.), Capital Medical University, Beijing, China; and Graduate School, Chinese Academy of Sciences, Beijing, China (W.W.).

Address correspondence to Wei Wang, MD, PhD, School of Public Health and Family Medicine, Capital Medical University, 100069 Beijing, China. E-mail: wei6014{at}yahoo.com

Objectives. The purpose of this study was to evaluate the diagnostic accuracy of prenatal screening for congenital heart disease (CHD) based on a combination of the 4-chamber view and 3-vessel view in an unselected population. Methods. A prospective study on 8025 scanned fetuses was performed. All singleton pregnancies scheduled for routine prenatal sonographic screening at 20 to 24 weeks’ gestation and subsequently delivered in our unit were included. Data were recorded regarding visualization of the 4-chamber view, outflow tracts, and 3-vessel view. Suspected CHD was confirmed by postmortem or postnatal echocardiography. We obtained follow-up data for the neonates and calculated the diagnostic accuracy of the examinations. Results. Major CHD was identified in 32 cases (4.0%), of which 26 (81.3%) were diagnosed antenatally and 6 (18.7%) postnatally. Four cases (0.5%) had false-positive findings. Twenty-one cases were identified by the 4-chamber view and 5 by an abnormal 3-vessel view. The sensitivity of the 4-chamber view alone was 65.6%, and the specificity was 99.9%. The sensitivity of the combination of the 4-chamber view and 3-vessel view was 81.3%, and the specificity was 99.9%. Conclusions. The 3-vessel view is a reliable and easy method to be used in a routine antenatal clinic along with the 4-chamber view.

Key Words: congenital heart disease • prenatal diagnosis • sonographic screening • 3-vessel view

Abbreviations: AO, ascending aorta • AVSD, atrioventricular septal defect • CHD, congenital heart disease • CoA, coarctation of the aorta • DORV, double-outlet right ventricle • NPV, negative predictive value • PA, pulmonary artery • PPV, positive predictive value • PS, pulmonary stenosis • SVC, superior vena cava • TA, truncus arteriosus • TGA, transposition of the great arteries • VSD, ventricular septal defect