Journal of Ultrasound in Medicine, Vol 13, Issue 4 285-289, Copyright © 1994 by American Institute of Ultrasound in Medicine
Four-chamber view of the fetal heart: demonstration related to menstrual age
S. M. Shultz, D. H. Pretorius and N. E. Budorick
Department of Radiology, University of California, San Diego, La Jolla 92093-0657.
The four-chamber view of the fetal heart is the most widely used screening
examination for the detection of structural cardiac abnormalities during
routine fetal ultrasonography. A prospective study of 520 consecutive
routine fetal sonograms taken between 13 and 39 weeks of gestational age
was performed to determine the frequency of obtaining a satisfactory
four-chamber view, focusing on fetuses of less than 19 weeks' menstrual
age. Menstrual age was a significant variable in procuring a satisfactory
four-chamber view. Visualization of a normal four-chamber view on film
progressively increased from five out of 15 (33%) at 14 weeks of menstrual
age to 35 out of 38 (92%) at 19 weeks of menstrual age; real-time
evaluation improved visualization to six out of 15 (40%) at 14 weeks of
menstrual age and to 36 out of 38 (95%) at 19 weeks of menstrual age.
Visualization in all fetuses scanned before 19 weeks' menstrual age
improved from 62 (on film only) to 75% (real-time and film). Abnormalities
on the four-chamber view were demonstrated before 19 weeks of menstrual age
in four cases. Although not all serious cardiac defects can be detected,
the four-chamber view remains a reliable screening examination of the fetal
heart even early in gestation.
