Assessment of Coronary Arteries during the Prenatal and Postnatal Periods using Two- and Three-dimensional Ultrasound

Coronary artery (CA) development is a complex process that begins early in embryogenesis and continues throughout fetal and postnatal life, with important implications for cardiovascular health. This review summarizes current knowledge on CA embryology, physiology, and imaging assessment across the fetal-neonatal continuum, with particular emphasis on advances in prenatal and postnatal ultrasonography. Prenatal evaluation using two-dimensional (2D) ultrasonography and three-dimensional techniques, including spatiotemporal image correlation and advanced flow-rendering modalities, has expanded the ability to visualize CA anatomy in selected fetal conditions, particularly in the presence of abnormal coronary dilation or altered hemodynamics, although routine assessment of normal fetal CAs remains challenging. In the postnatal period, 2D transthoracic echocardiography remains the cornerstone for the diagnosis and follow-up of CA anomalies, aneurysms, and fistulas, supported by standardized measurement protocols and Z-score normalization. Complementary imaging modalities, such as computed tomography and magnetic resonance coronary angiography, provide additional anatomical detail in selected cases. A comprehensive understanding of CA development and imaging across early life is essential for improving diagnostic accuracy, guiding clinical management, and optimizing long-term cardiovascular outcomes.