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J Ultrasound Med. 2018 Aug;37(8):1869-1880. doi: 10.1002/jum.14533. Epub 2017 Dec 27.

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

Author information

1
Center for Prenatal Diagnostics, Opole, Poland.
2
Dobreusg Ultrasound Group Practice, Krakow, Poland.
3
Departments of Gynecology and Obstetrics, Jagiellonian University, Krakow, Poland.
4
Polish Mother's Memorial Hospital Research Institute, Lodz, Poland.
5
Profemi Private Practice, Krotoszyn, Poland.
6
Departments of Pediatric Cardiology, Jagiellonian University, Krakow, Poland.
7
Department of Gynecology and Obstetrics, Frederic Chopin Clinical District Hospital No. 1, Rzeszow, Poland.

Abstract

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.

KEYWORDS:

double-outlet right ventricle; early fetal echocardiography; first-trimester ultrasonography; obstetrics; prenatal ultrasonography; tetralogy of Fallot

PMID:
29280176
DOI:
10.1002/jum.14533
[Indexed for MEDLINE]

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