Four chamber cardiac view (fetal)

Changed by Ayush Goel, 18 Dec 2016

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The four chamber cardiac view is an important and routinely performed view in both fetal echocardiography as well as on a standard second trimester anatomy scan.

Detectable pathology

The four chamber view can only detect some of the congenital cardiac anomalies (~64% according to one study²) that can be detected antenatally and these include:

septal defects
- large ventricular septal defects
- endocardial cushion defects: AV canal defects
hypoplastic left heart syndrome
persistent truncus arteriosus
presence of echogenic intracardiac foci (EIF)

Anomalies that may not be apparent on the four chamber view alone include transposition of the great arteries and aortic coarctation.

Radiographic features

It is assessed on an axial (transverse) plane through the fetal thorax.

Features to evaluate:

situs: establish heart on the left side, same side as fetal stomach
axis: cardiac apex normally points to the left, at an angle of 45^o+/-20^o
heart size: should occupy approximately 1/3rd of the thoracic area
heart location: any mediastinal shift or ectopia cordis
heart rate: normal 120-160 bpm
atrial chambers: similar in size, with foramen ovale flap opening to the left atrium.
ventricular chambers: the morphologic right ventricle should be located immediately behind the sternum and is characterized by the presence of the moderator band
interventricular and interatrial septa (with possible defects)
atrioventricular valves: tricuspid valve (right heart) septal leaflet inserts into the septum more anterior than the mitral valve (left heart) - the normal valve offset.

Image 2 Ultrasound (4 CH view) ( update )

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Case 1: four chamber view showing an EIF

Image 4 Ultrasound ( update )

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Case 2: four chamber view showing a small VSD

Image 5 Annotated image (4 chamber) ( update )

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Case 3: ~~Normal~~normal situs and axis

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