title: Diagnosis of fetal ductus arteriosus aneurysm: importance of the three-vessel view.
abstract: 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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Cardiology, Department of Paediatrics, Children's and Women's Health Centre of British Columbia and The University of British Columbia, Vancouver, B.C., Canada.
authors.forename: C M
authors.initials: CM
authors.lastname: Jackson
authors.forename: G G S
authors.initials: GG
authors.lastname: Sandor
authors.forename: K
authors.initials: K
authors.lastname: Lim
authors.forename: W J
authors.initials: WJ
authors.lastname: Duncan
authors.forename: J E
authors.initials: JE
authors.lastname: Potts
mesh_terms: D000328:Adult; D000783:Aneurysm / Q000000981:diagnostic imaging*; D001011:Aorta / Q000000981:diagnostic imaging; D001788:Blood Grouping and Crossmatching; D016640:Diabetes, Gestational / Q000000981:diagnostic imaging; D004373:Ductus Arteriosus / Q000000981:diagnostic imaging*; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D015160:Hydrops Fetalis / Q000000981:diagnostic imaging; D008180:Lupus Erythematosus, Systemic / Q000000981:diagnostic imaging; D011247:Pregnancy; D011256:Pregnancy Outcome; D011651:Pulmonary Artery / Q000000981:diagnostic imaging; D016216:Ultrasonography, Prenatal / Q000379:methods*; D014683:Vena Cava, Superior / Q000000981:diagnostic imaging