Fetal intracardiac echogenic foci: Current understanding and clinical significance

The detection of fetal intracardiac echogenic foci (ICEF) by ultrasound was first reported in 1987. Despite many investigations, the relationship of I CEF with congenital heart malformations and chromosomal abnormalities remai ns unclear. This review describes the current understanding of ICEF based o n a literature search from 1980 to the present. ICEF are observed in 0.5 to 20 percent of fetuses, with an overall frequency of 5.6 percent. These sma ll, discrete structures near the papillary muscles and chordae tendinae mov e in synchrony with the intraventricular valves. They likely represent micr ocalcification of the papillary muscles. ICEF are most commonly seen in the left ventricle and occasionally in the right ventricle or bilaterally. Int ra-atrial or diffuse ICEF are rare. In the chromosomally normal fetus, ICEF are not associated with congenital heart defects. The presence of ICEF in fetuses at high risk for chromosomal abnormalities suggests an increased po ssibility of aneuploidy, especially if other sonographic markers are noted. A similar association is observed with trisomy 21 in particular. The signi ficance of ICEF in fetuses at low risk for aneuploidy is less clear and rep resents an area for future research.