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Clinical Implications of the Prenatal Sonographic Finding of Fetal Myocardial Echogenic Foci

Department of Obstetrics and Gynecology, Divisions of Fetal Imaging (I.M.V., R.A.B., C.H.C.) and Maternal-Fetal Medicine (R.A.B.), William Beaumont Hospital, Royal Oak, Michigan USA; and Chicago, Illinois USA (N.J.H.).

Address correspondence and reprint requests to Ivana M. Vettraino, MD, Department of Obstetrics and Gynecology, Division of Fetal Imaging, William Beaumont Hospital, 3601 W Thirteen Mile Rd, Royal Oak, MI 48073-6769 USA. E-mail: ivettraino{at}beaumonthospitals.com

Objective. The purpose of this study was to investigate the clinical implications of fetal echogenic foci limited to the myocardium of the ventricular wall (EMF) or intraventricular septum detected during prenatal sonography. Methods. A retrospective review of fetuses found to have EMF during prenatal sonography from April 1990 through December 2003 was undertaken. Videotapes and reports were reviewed to determine the indication for sonography, gestational age, location, sonographic characteristics of the masses, and additional fetal findings. Sources of outcome data included neonatal and pediatric records and echocardiographic reports. Results. Five fetuses were identified. Indications for sonographic evaluation included fetal growth (n = 4) and follow-up twin-twin transfusion syndrome (n = 1). Mean gestational age ± SD at diagnosis was 23.7 ± 8.0 weeks (range, 17.1–36.4 weeks). The EMF identified were within the right ventricular myocardium (n = 2), intraventricular septum (n = 1), left ventricular myocardium (n = 1), and myocardium of the cardiac apex (n = 1). All foci appeared sonographically "bright as bone." The foci ranged in size from 0.1 x 0.1 to 1.2 x 0.9 cm. Neonatal echocardiographic findings were reported as normal for each of the cases. Follow-up examinations available for up to 2.5 years of age showed normal cardiac function. Conclusions. The prenatal identification of EMF is unlikely to lead to notable short-term pathologic conditions because the fetuses in this investigation had unremarkable neonatal and pediatric echocardiograms and normal cardiac function.

Key Words: echogenic focus • fetal echocardiogram • myocardial calcification

Abbreviations: EMF, echogenic foci limited to the myocardium