Sonographic evaluation of the fetal heart is an important part, of obs
tetric sonography. The sonographer and sonologist should be familiar w
ith the sonographic appearance of the normal fetal heart and with comm
on structural abnormalities. Occasionally, normal structures in or adj
acent to the fetal heart may simulate an abnormality. Although one sho
uld seek consultative sonography in instances of uncertain or question
able findings, unnecessary referral and concern may be avoided in some
cases if the sonologist is familiar with normal variants and pitfalls
. In this pictorial essay, we present several such pitfalls that we an
d others have observed in the four-chamber view (Fig. 1) and in views
of the ventricular outflow tracts (Figs. 2 and 3).