Influence of Fetal Heart Orientation on the Sonographic Identification of an Echogenic Intracardiac Focus in the Left Ventricle

The objective of this study was to compare the ability to visualize an echogenic intracardiac focus (EIF) of the left ventricle in four different cardiac projections. One hundred seventeen fetuses at 15 to 24 weeks’ gestation with a known EIF were rescanned in at least one longitudinal cardiac plane (apical or basilar) and one lateral plane (left or right lateral). An EIF was recorded as present if an intensely bright focus was visualized within the left ventricle. An EIF was identified in 100% (111/111) of apical views, 49.2% (29/59) of left lateral views, 46.8% (29/62) of right lateral views, and 100% (12/12) of basilar views. An EIF was seen in 100% of longitudinal views compared with 48.7% of lateral views (P < .001). It was concluded that an EIF is more consistently seen from the apical and basilar views than from the right or left lateral views of the fetal heart. A longitudinal view of the heart is required to truly rule out an EIF.