The Three-Y and Trachea View (3Y + T): A Conceptual Extension of the Three-Vessel and Trachea View for Comprehensive Fetal Echocardiographic Assessment.

Introduction

Congenital heart disease remains the most common congenital anomaly and a leading cause of infant morbidity and mortality. Although the three-vessel and trachea view has substantially improved prenatal assessment of the great arteries and aortic arch anatomy, detailed evaluation of the distal arch, aortic isthmus, and arch convergence may remain challenging in routine fetal echocardiography.

Methods

A structured literature review of PubMed-indexed studies was conducted to examine the anatomical basis, clinical applications, diagnostic performance, and technological developments related to the three-vessel and trachea views. The reviewed evidence served as the scientific basis for the development of the proposed Three-Y and Trachea concept. Results and Discussion: The three-vessel and trachea view provides a standardized transverse assessment of the great vessels and contributes substantially to the prenatal detection of conotruncal and aortic arch anomalies. Building on this established approach, the proposed Three-Y and Trachea concept emphasizes the Y-shaped convergence of the ductal arch and transverse aortic arch at the level of the aortic isthmus, while preserving the trachea as a key anatomical landmark. This additional anatomical perspective may facilitate assessment of arch continuity, aortic isthmus morphology, and flow relationships within the upper mediastinum while highlighting the anatomical and hemodynamic significance of the aortic isthmus within the fetal circulation.

Conclusions

The Three-Y and Trachea view represents a conceptual extension of the conventional three-vessel and trachea view that may offer a more comprehensive framework for anatomical and functional evaluation of the fetal aortic arch and aortic isthmus. Further prospective studies are required to assess its feasibility, reproducibility, and potential clinical value in prenatal cardiac screening.