Is an isolated fetal cardiac echogenic focus an indication for fetal echocardiography?

Objective. To determine whether the presence of an isolated fetal cardiac e chogenic focus should be an indication for fetal echocardiography. Methods. We reviewed our fetal echocardiography and obstetrics databases from Janua ry 1992 through July 1999. The study groups were formulated from patients r eferred for fetal echocardiography. Patients referred for echocardiography because of a single isolated fetal cardiac echogenic focus were compared wi th patients referred for other indications. The sensitivity, specificity, a nd positive and negative predictive values were calculated for an isolated echogenic focus as a marker for structural cardiac abnormalities as detecte d by fetal echocardiography. Results Of 10,406 fetuses seen for ultrasonogr aphy, 1908 had fetal echocardiography. Cardiac abnormalities were identifie d in 3.4% (65 of 1908) of the fetuses that had echocardiography. The preval ence of an isolated echogenic focus was 2.2% (230 of 10,406) and was the in dication in 12.1% (230 of 1908) of our echocardiograms. Only 1 of the 230 f etuses with an isolated echogenic focus had a structural cardiac defect (me mbranous ventricular septal defect). An isolated echogenic focus as a marke r for congenital cardiac defects resulted in sensitivity and specificity of 1.5% and 87.6%, respectively. The positive and negative predictive values were 0.4% and 96.2%, respectively. The relative risk for an echogenic focus in predicting congenital cardiac defects was 0.11 (95% confidence interval , 0.02-0.82). Conclusions. An isolated fetal cardiac echogenic focus is not an efficacious marker for congenital cardiac defects. It should not be the sole indication for fetal echocardiography.