Prenatal diagnosis of congenital cardiac anomalies: a practical approach using two basic views

Structural cardiac anomalies are estimated to occur in 8 of every 1,000 live births. Cardiovascular anomalies are frequently associated with other congenital anomalies because the heart is among the last organs to develop completely in the embryo. The guidelines for routine prenatal evaluation of both the American College of Radiology and the American Institute of Ultrasound in Medicine require evaluation of the fetal heart. The ultrasonographic (US) view that is most commonly used is the four-chamber view, which allows assessment of abnormalities involving the atria and the ventricles. However, this view is not adequate for demonstrating the outflow tracts of the aorta and pulmonary artery. A base view that demonstrates the crossing of the great vessels can be obtained just superior to the four-chamber view. Addition of the base view to routine US evaluation with the four-chamber view increases not only the sensitivity for detection of cardiac anomalies but also the accuracy of diagnosis.