Three cross-sectional planes for fetal color Doppler echocardiography

Routine use of color Doppler during every fetal cardiac examination remains controversial. Many examiners still believe that color should be reserved for cases of suspected congenital heart defect (CHD). In our opinion, color Doppler should be applied in every cardiac scan due to the increase in speed and accuracy that it allows. The purpose of this review is to first explain how color Doppler presets can be optimized and, second, to propose the use of three cross-sectional planes to simplify color Doppler fetal echocardiography: the four-chamber (4CV), five-chamber (5CV) and three-vessel (3VV) views. A practical approach to the detection of CHD with these planes is presented, with typical findings and possible abnormalities evident during systole and diastole. The diastolic pattern on the 4CV is characterized by two equal color stripes. Connection ('H'-sign) or size inequality of the two stripes, or a unilateral color stripe, are important abnormal findings. In systole valve regurgitation should be excluded. In the 5CV, turbulent flow, ventricular septal defect or an overriding aorta ('Y'-sign) can be detected. In the 3VV the aorta and pulmonary trunk should be of nearly equal size and demonstrate antegrade flow. Abnormal findings encountered include absence of one vessel, discrepant size of the vessels, retrograde flow in one of the vessels, or the 'U'-sign, where the trachea is enclosed between both vessels, suggesting right-sided aortic arch. In summary, we propose that color Doppler examination utilizing these three planes alone is sufficient to obtain adequate information for the detection of most common CHD.