What causes aortic hypoplasia in a three-vessel (3V) view?

From the Guidelines

Aortic hypoplasia in a three-vessel (3V) view is typically caused by congenital heart defects, such as coarctation of the aorta, which can be associated with other cardiovascular anomalies, including aortic arch anomalies and dysplasia 1.

Key Factors

• Cardiovascular anomalies: Coarctation of the aorta, aortic arch anomalies, and dysplasia are common causes of aortic hypoplasia in a 3V view 1.
• Genetic and congenital diseases: Conditions like PHACE syndrome, which is characterized by posterior fossa anomalies, hemangiomas, and cardiovascular anomalies, can also contribute to aortic hypoplasia 1.
• Aortic diseases: Heritable disorders, such as Marfan syndrome, and congenital heart diseases, like bicuspid aortic valve, can affect the thoracic aorta and lead to aortic hypoplasia 1.

Important Considerations

• Imaging: Detailed imaging of the aortic arch, using techniques like MRI or MRA, is essential for diagnosing and managing aortic hypoplasia 1.
• Risk factors: Hypertension, advanced maternal age, and certain medications, such as beta-blockers, can increase the risk of aortic hypoplasia 1.
• Fetal conditions: Intrauterine growth restriction, chromosomal abnormalities, and other fetal conditions can also be associated with aortic hypoplasia, requiring further evaluation and monitoring 1.

From the Research

Causes of Aortic Hypoplasia in a Three-Vessel (3V) View

• Aortic hypoplasia can be caused by various congenital heart defects, including interrupted aortic arch (IAA) 2
• In IAA, the three-vessel view (3VV) shows a large discrepancy between the diameter of the larger, dilated pulmonary artery (PA) and smaller, narrow aortic arch (Ao) 2
• The calculated ratio of PA/Ao in fetuses with IAA is significantly higher than in normal controls, with a ratio of 2.6 ± 0.4 compared to 1.1 ± 0.09 2
• Other studies have also shown that the 3VV can be used to detect abnormalities in the great arteries, including aortic stenosis and pulmonary stenosis 3, 4
• The three-vessel-trachea view (3VT view) has also been shown to be useful in diagnosing fetal cardiac great vessel malformation, including abnormalities in blood vessel position, diameter, and number 5

Detection of Aortic Hypoplasia

• The 3VV has a high detection rate for congenital heart defects, including those that cause aortic hypoplasia 3
• The detection rate of abnormal blood vessel diameter using the 3VT view is 95%, making it a useful tool for detecting aortic hypoplasia 5
• Color Doppler flow imaging can also be used to detect abnormalities in blood flow direction and branch, which can be indicative of aortic hypoplasia 5

Importance of the Three-Vessel View

• The 3VV is a simple and easy-to-obtain view that can be used to detect abnormalities in the great arteries, including aortic hypoplasia 4
• The 3VV can be used in conjunction with other echocardiographic views to improve the detection rate of congenital heart defects 3, 6
• The use of the 3VV and 3VT view can help to improve prenatal diagnosis and treatment of congenital heart defects, including those that cause aortic hypoplasia 2, 5