From the four-chamber view, the pulmonary trunk origin from the right ventricle can be visualized in the three-vessel view, by sliding the transducer cranially while maintaining the transverse orientation in the chest ( Fig. 8.1), the left ventricular outflow tract (the aorta), referred to as the five-chamber view, can be imaged by a slight tilt or rotation of the medial aspect of the transducer in the direction of the fetal head ( Fig. Obtain a four-chamber view of the fetal heart (see Chapter 7).ģ. Determine the fetal situs (see Chapter 6).Ģ. SCANNING TECHNIQUE FOR AXIAL VIEWS OF THE OUTFLOW TRACTSġ.The authors believe that this approach is best adapted to fetal cardiac imaging ( 4, 5). Cardiac views that are neither near transverse nor near sagittal are referred to as oblique views. Transverse views are therefore obtained from a transverse, or near-transverse, orientation of the ultrasound transducer to the fetal spine, and sagittal views are obtained from a sagittal or parasagittal orientation of the ultrasound transducer to the fetal spine. In this chapter, we will rely on the anatomic approach of various diagnostic planes as it relates to the anatomic long axis of the fetus (fetal spine), rather than the long axis of the heart itself. The orientation and access to the fetal heart differ from postnatal scanning. Furthermore, a comprehensive evaluation of the fetal venous system will be presented in Chapter 10. The three-vessel trachea view, an axial (transverse) view obtained in the upper mediastinum, has received special attention in the past several years ( 1, 3) and thus will be presented in detail in Chapter 9.

In this chapter, we present the various ultrasound diagnostic planes that are required for a comprehensive prenatal evaluation of the great vessels. The anatomy of the great vessels was reviewed in detail in Chapter 5. Multiple cardiac ultrasound imaging planes are thus required for the evaluation of the great vessels. Adequate visualization of the great vessels on ultrasound includes demonstration of the origin of the aorta and pulmonary artery from the left and right ventricles, respectively, vessel size, anatomic relationship, and alignment and course of the great vessels ( 1). Many major congenital heart anomalies, especially the conotruncal type, may escape prenatal detection if the ultrasonographic cardiac evaluation is limited to the four-chamber view. It is assessed on an axial (transverse) plane through the fetal thorax.The visualization of the great vessels is currently part of the basic obstetric ultrasound examination, and thus a good understanding of the anatomic relationship of the great vessels and the related ultrasound views is essential to the successful performance of the obstetric ultrasound examination ( 1, 2). presence of echogenic intracardiac foci (EIF)Īnomalies that may not be apparent on the four chamber view alone include transposition of the great arteries and aortic coarctation.

endocardial cushion defects: AV canal defects.

The four chamber view can only detect some of the congenital cardiac anomalies (~64% according to one study 2) that can be detected antenatally and these include:

Images for fetal echo cardiograph views