"Y Sign" at the Level of the 3-Vessel and Trachea View: An Effective Fetal Marker of Aortic Dextroposition Anomalies in the First Trimester.

Autor: Pasternok M; Center for Prenatal Diagnostics, Opole, Poland., Nocun A; Dobreusg Ultrasound Group Practice, Krakow, Poland., Knafel A; Departments of Gynecology and Obstetrics, Jagiellonian University, Krakow, Poland., Grzesiak M; Polish Mother's Memorial Hospital Research Institute, Lodz, Poland., Orzechowski M; Profemi Private Practice, Krotoszyn, Poland., Konarska K; Departments of Pediatric Cardiology, Jagiellonian University, Krakow, Poland., Ludwin A; Dobreusg Ultrasound Group Practice, Krakow, Poland., Ludwin I; Dobreusg Ultrasound Group Practice, Krakow, Poland., Zymroz P; Department of Gynecology and Obstetrics, Frederic Chopin Clinical District Hospital No. 1, Rzeszow, Poland., Parzynska A; Departments of Gynecology and Obstetrics, Jagiellonian University, Krakow, Poland., Wiechec M; Dobreusg Ultrasound Group Practice, Krakow, Poland.; Departments of Gynecology and Obstetrics, Jagiellonian University, Krakow, Poland.
Jazyk: angličtina
Zdroj: Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine [J Ultrasound Med] 2018 Aug; Vol. 37 (8), pp. 1869-1880. Date of Electronic Publication: 2017 Dec 27.
DOI: 10.1002/jum.14533
Abstrakt: Objectives: The "Y sign" at the level of the 3-vessel and trachea view corresponds to thinning of main pulmonary artery and arterial duct and a dilated transverse aortic arch. The purpose of this study was to evaluate the Y sign for the diagnosis of aortic dextroposition anomalies at the time of the first-trimester scan and to assess the screening performance of only the Y sign, only abnormal left axis deviation (axis sign), and their combination for the diagnosis of aortic dextroposition anomalies.
Methods: A prospective evaluation of 6025 pregnant women undergoing first-trimester ultrasonography was conducted. The cardiac axis was measured in all examined patients and considered abnormal (positive axis sign) at greater than 57 °. The frequency of the Y sign and the axis sign was assessed for this population, and their screening performance for the diagnosis of aortic dextroposition anomalies was calculated.
Results: A total of 5775 patients fulfilled the inclusion criteria. Aortic dextroposition anomalies were diagnosed in 17 cases (tetralogy of Fallot in 8 and Fallot-like double-outlet right ventricle in 9). The Y sign was found in 18 of 5775 (0.3%) fetuses examined, of which 7 of 18 were confirmed with tetralogy of Fallot, 9 of 18 with a Fallot-like double-outlet right ventricle, and 2 of 18 with pulmonary stenosis. A positive axis sign of greater than 57 ° was found in 20 fetuses, including 4 with normal heart anatomy. The sensitivity values of the Y sign, the axis sign, and their combination were 94%, 76%, and 94%, respectively.
Conclusions: Visualization of the Y sign should increase the suspicion of aortic dextroposition anomalies in the late first trimester. The screening performance of the Y sign alone and in combination with an abnormal cardiac axis was high and may aid in the early diagnosis of aortic dextroposition anomalies in the fetus.
(© 2017 by the American Institute of Ultrasound in Medicine.)
Databáze: MEDLINE
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