Echogenic foci within the fetal heart have been reported in association with cardiac tumors and chromosomal abnormalities. They have been observed also as a normal variant of cardiac development. The goal of this study was to analyze the frequency, distribution and natural history of echogenic foci within the fetal heart. A total of 1139 patients referred for targeted ultrasound were studied. Patients with positive findings (presence of the echogenic foci) were referred for serial fetal echocardiographic examinations at 26-28 weeks and 34-36 weeks of pregnancy. Neonatal follow-up examinations were performed within the first 3 months of life in 27 cases. Ventricular echogenic foci were seen in 3.6% of fetuses. The locations of the echogenic foci were as follows: left ventricle, 92.8%; right ventricle, 4.8%; both ventricles, 2.4%. All fetuses had a normal karyotype. Echogenic foci remained present in all infants who underwent echocardiographic examination within the first 3 months of life. Echogenic intracardiac foci probably represent a normal variant of the development of papillary muscles and chordae tendinae.

Nine fetuses with unusually appearing echogenic foci were selected from a series of 65 fetuses with intracardiac echogenic foci studied at the Fetal Diagnosis and Treatment Unit from January 1994 until February 1996. An echogenic focus or foci were defined as a structure or structures within the fetal heart with echogenicity similar to or greater that that of the surrounding bone. Unusually appearing foci were defined as lesions of unusual size, shape, structure or location. Three fetuses had unusually large echogenic foci, and four had multiple foci in both ventricles. In one fetus, two echogenic foci were very close to each other, creating an impression of a 'double' focus within the left ventricle. In another fetus, three echogenic foci were detected. Follow-up protocol for fetuses with echogenic foci included comprehensive ultrasound, amniocentesis and fetal echocardiography. All studied fetuses had normal karyotype. A fetal echocardiogram failed to reveal congenital heart defects. The neonatal outcome was uneventful in seven out of nine cases; one patient decided to terminate her pregnancy for reasons unrelated to the ultrasound findings, and one delivered prematurely at 34 weeks of pregnancy. In conclusion, we failed to find any correlation between unusually appearing echogenic foci and adverse perinatal outcome.

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Congenital aneurysm of the right atrium was diagnosed in a 17‐week fetus. It appeared as an outward bulge of the right atrium which doubled its size. The aneurysm was akinetic. Flow across the atrioventricular valves appeared unobstructed. The fetus had no evidence of cardiac failure. The patient elected to terminate the pregnancy. Autopsy results were confirmatory.