Four chamber cardiac view (fetal)

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

Pathology

Detectable pathology

The four chamber view can only detect some of thecongenital cardiac anomalies(~64% according to one study 2) that can be detected antenatally and these include

Anomalies that may not be apparent on the four chamber view alone includetransposition of the great arteries andaortic coarctation.

Radiographic features

It is assessed on an axial (transverse) plane through through the fetal thorax. In the usual situation, the heart is seen with the apex pointing towards the left at an angle of ~45-50o +/- 20o on this view. The ventricles lie closer to the anterior thoracic wall and are close to the same size.

Features to evaluate

  • sizesitus: establish heart on the left side, same side as fetal stomach
  • axis:  cardiac apex normally points to the left, at an angle of individual chambers, overall 45o+/-20o
  • heart size: should occupy approximately 1/3rd of the thoracic area
  • number of heart chambers and locationrate: normal 120-160bpm
  • contractility
  • interventricular and interatrial septa (with possible defects)
  • atrioventricular valves
    •

Aatrial chambers: similar in size, with foramen ovale can be seen interrupting the interatrial septum, with the flap of the foramen always opening towardto the left atrium. The

  • ventricular chambers: the morphologic
    • right ventricle should be located located immediately behind the sternum and is characterized by the presence of the moderator band. Normally, both ventricles are approximately
  • interventricular and interatrial septa (with possible defects)
  • atrioventricular valves: tricuspid valve (right heart) septal leaflet inserts into
    •  the same size. The left ventricle is posterior and is to the left of the right ventricle, andseptum more anterior than the mitral valve insertion is slightly cephalad to(left heart) - the insertion of the tricuspidnormal valve offset.

    See also

    • -<p>The <strong>four chamber cardiac view</strong> is an extremely important and routinely performed view in both <a href="/articles/fetal-echocardiography-views">fetal echocardiography</a> as well as on standard <a href="/articles/second-trimester-ultrasound-scan">second trimester anatomy scan</a>.</p><h4>Pathology</h4><h4>Detectable pathology</h4><p>The four chamber view can only detect some of the <a href="/articles/congenital-cardiovascular-anomalies">congenital cardiac anomalies </a>(~64% according to one study<sup> 2</sup>) that can be detected antenatally and these include</p><ul>
    • +<p>The <strong>four chamber cardiac view</strong> is an important and routinely performed view in both <a href="/articles/fetal-echocardiography-views">fetal echocardiography</a> as well as on standard <a href="/articles/second-trimester-ultrasound-scan">second trimester anatomy scan</a>.</p><h4>Pathology</h4><h4>Detectable pathology</h4><p>The four chamber view can only detect some of the <a href="/articles/congenital-cardiovascular-anomalies">congenital cardiac anomalies </a>(~64% according to one study<sup> 2</sup>) that can be detected antenatally and these include</p><ul>
    • -<li>large <a href="/articles/ventricular-septal-defect-1">ventricular septal defects</a>
    • +<li>large <a href="/articles/ventricular-septal-defect-1">ventricular septal defects</a>
    • -<li>presence of <a href="/articles/echogenic-intracardiac-focus">echogenic intracardiac foci (EIF)</a>
    • +<li>presence of <a href="/articles/echogenic-intracardiac-focus">echogenic intracardiac foci (EIF)</a>
    • +</li>
    • +</ul><p>Anomalies that may not be apparent on the four chamber view alone include <a href="/articles/transposition-of-the-great-arteries">transposition of the great arteries</a> and <a href="/articles/coarctation-of-the-aorta">aortic coarctation</a>.</p><h4>Radiographic features</h4><p>It is assessed on an axial (transverse) plane through the fetal thorax.</p><p>Features to evaluate</p><ul>
    • +<li>situs: establish heart on the left side, same side as fetal stomach</li>
    • +<li>axis:  cardiac <span style="line-height:18.9091px">apex normally points to the left, at an angle of 45</span><sup>o</sup><span style="line-height:18.9091px">+/-20</span><sup>o </sup>
    • +</li>
    • +<li>heart size: should occupy approximately 1/3rd of the thoracic area</li>
    • +<li>heart rate: normal 120-160bpm</li>
    • +<li>atrial chambers: similar in size, with foramen ovale flap opening to the left atrium.</li>
    • +<li>ventricular chambers: the morphologic right ventricle <span style="line-height:18.9091px">should be located immediately behind the sternum and is characterized by the presence of the </span><a style="line-height: 18.9091px;" href="/articles/moderator-band">moderator band</a>
    • -</ul><p>Anomalies that may not be apparent on the four chamber view alone include <a href="/articles/transposition-of-the-great-arteries">transposition of the great arteries</a> and <a href="/articles/coarctation-of-the-aorta">aortic coarctation</a>.</p><h4>Radiographic features</h4><p>It is assessed on an axial (transverse) plane through the fetal thorax. In the usual situation, the heart is seen with the apex pointing towards the left at an angle of ~45-50<sup>o</sup> +/- 20<sup>o </sup>on this view. The ventricles lie closer to the anterior thoracic wall and are close to the same size.</p><p>Features to evaluate</p><ul>
    • -<li>size of individual chambers, overall heart size</li>
    • -<li>number of heart chambers and location</li>
    • -<li>contractility</li>
    • -<li>atrioventricular valves</li>
    • -</ul><p>A foramen ovale can be seen interrupting the interatrial septum, with the flap of the foramen always opening toward the left atrium. The right ventricle should be located immediately behind the sternum and is characterized by the presence of the <a href="/articles/moderator-band">moderator band</a>. Normally, both ventricles are approximately the same size. The left ventricle is posterior and is to the left of the right ventricle, and the mitral valve insertion is slightly cephalad to the insertion of the tricuspid valve. </p><h4>See also</h4><ul><li><a href="/articles/fetal-echocardiography-views">fetal echocardiography views</a></li></ul>
    • +<li>atrioventricular valves: tricuspid valve (right heart) septal leaflet inserts into the septum more anterior than the mitral valve (left heart) - the normal valve offset.</li>
    • +</ul><h4>See also</h4><ul><li><a href="/articles/fetal-echocardiography-views">fetal echocardiography views</a></li></ul>

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