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Abstract
Background : A representational illustrated cardiac schema is useful for understanding and interpreting normal and abnormal fetal echocardiographic findings.
Aim : Normal and abnormal fetal echocardiographic images can be better appreciated with the support of sectional schemas.
Settings and Design : An attempt is made to include normal and abnormal variations in both grayscale and color images for easy understanding with the help of the schemas.
Materials and Methods : The fetal cardiac sectional schemas are drawn by the author, using Microsoft Office Word drawing canvas. It is based on the best grayscale, color Doppler, power-angio, 3-dimensional, and high definition flow ultrasound images, supported by embryological and anatomic specimens in literature. Different sections are drawn in accordance with the planes suggested by Society for Maternal-Fetal Medicine, Society of Radiologists in Ultrasound, American College of Obstetricians and Gynecologists, American Institute of Ultrasound in Medicine, American College of Radiology, and American Society of Echocardiography. Every effort has been meticulously pursued to match with the best ultrasound images with minor modifications for better clarity, understanding, and reproducibility.
Results : The drawings include normal and most of the common cardiac anomalies depicting different sectional views starting from the abdomen and upward. Each drawing complies with the ultrasound images. Users with basic computer knowledge can easily modify these images using them as templates for reference, reporting, and publications.
Conclusions : An attempt is made to represent the fetal echocardiographic images by simplified memorable sectional schemas. These schemas will facilitate a better understanding and interpretation of various normal and abnormal fetal echocardiographic images. Being electronically transmittable, these schemas can be used as templates for further modifications.
Keywords: Congenital heart diseases, echocardiography, fetal cardiac anomalies, fetal cardiac drawings, fetal cardiac schemas, fetal, prenatal ultrasonography
How to cite this article: Introduction 
With the advent of high-quality images of the fetal heart, targeted imaging helps to diagnose most fetal cardiac anomalies. This helps to segregate those fetuses with serious cardiac anomalies and plan the delivery at a well-equipped referral center. Schemas provided here can serve as reference diagrams to define normal and abnormal fetal cardiac anatomy. This is the first part of successive groups of drawings.
Materials and Methods Various fetal echocardiographic images are reviewed and incorporated into these simplified drawings. A short practical description is provided before each drawing. The blue/red color of the vessels is only representational and does not always correlate with the blood flow direction. Aliasing is shown by the conglomeration of different colors. The sagittal, parasagittal, and oblique schemas are configured assuming that the fetal head is on the right side and the caudal end is on the left side of the examiner. The axial sections are drawn with the fetal head in the lower uterine cavity and the spine along the right side of the examiner. The whole work is carried out by the authors, using the drawing canvas of Microsoft Office 2007.
Transabdominal and lower thoracic sections
The first step in sequential fetal echocardiography is to define the laterality of major visceral organs and vessels.[1] The upper abdominal axial (transverse) section and the cardiac four-chamber view determine the visceral situs. The inferior vena cava (IVC) is located posteriorly in a side-by-side position to the descending aorta in the lower abdominal axial sections. The relatively large size fetal liver occupies the major part of the rightside abdomen. The heart is situated mainly in the left hemithorax with its apex directed to the left levocardia. Normal spatial distribution of these visceral organs is termed “visceral situs solitus” [Figure 1].
Figure 1: Upper abdominal axial section shows the normal visceral situs solitus. The Liv, GB, PorS, and the IVC are on the right side. The IVC is right anterior to the DesAo. The DesAo is left and anterior to the Sp. The Sto and the sickle-shaped Spl are on the left side. The UV enters through the anterior central abdomen and its intra-hepatic portion joins the LPV and the PorS in an L-shape configuration. Liv: Liver, IVC: Inferior vena cava, GB: Gall bladder, PorS: Portal sinus, DesAo: Descending aorta, Sp: Spine, Sto: Stomach, Spl: Spleen, UV: Umbilical vein, LPV: Left portal veinAn upper abdominal oblique sectional drawing of a normal fetal abdomen shows the normal relations of the umbilical vein, ductus venosus, IVC, and hepatic veins. Color Doppler image is incorporated to show the flow direction [Figure 2].
Figure 2: Upper abdominal oblique section slightly angled superiorly, defines the normal major intrahepatic venous connections. The hepatic veins LHV, MHV, RHV, and the DV join the IVC. The DV is a short narrow vessel that continues from the UV with typical aliasing on color Doppler. The IVC on the right side forms a subdiaphragmatic vestibulum which enters the right atrium at the level of the diaphragm. DesAo: Descending aorta, Liv: Liver; Sp: Spine, LHV: Left hepatic vein, MHV: Middle hepatic vein, RHV: Right hepatic vein, DV: Ductus venosus, IVC: Inferior vena cava, UV: Umbilical veinThe umbilical-portal venous tributaries are small vessels with varying anatomic relationships and lie in closer relation to each other. Hence, it is often difficult to define more precise details.[2] These vessels are defined by an axial upper abdominal section with color Doppler [Figure 3].
Figure 3: Upper abdominal axial section with color Doppler shows normal intrahepatic umbilical-portal venous communications. The UV points to the right with an L-shape configuration. The PorS is formed by the confluence of the umbilical vein, DV, main portal vein (MPV, extrahepatic portal vein), and the left and right intrahepatic portal veins (LPV, RPV). The main and right intrahepatic portal veins show antegrade flow but the left intrahepatic portal vein flow is directed away from the transducer in this plane. The left intrahepatic portal vein tributaries are visible (1, 2, and 3 are the inferior, medial, and superior branches). DesAo: Descending aorta, IVC: Inferior vena cava, Sp: Spine, Sto: Stomach, UV: Umbilical vein, PorS: Portal sinus, DV: Ductus venosus, MPV: Middle portal veins, LPV: Left portal veins, RPV: Right portal veinsAbnormal laterality of abdominal and thoracic visceral arrangements manifests as situs inversus totalis and as heterotaxy syndromes. The visceral arrangement which manifests as a mirror image of the normal abdominal and thoracic viscera is called “situs inversus totalis” [Figure 4]. It has an incidence of approximately 1 in every 10,000–50,000 live births.[3] Associated cardiac anomalies can occur in 0.3%–5%. These are dextrocardia, septal defects, transposition of great arteries, abnormal atrioventricular valves, tetralogy of Fallot, double-outlet right ventricle (DORV), anomalous pulmonary venous return, pulmonary valve stenosis, coarctation of the aorta, absent coronary sinus, and conduction abnormalities. The associated extracardiac anomalies such as gastrointestinal anomalies and midline defects are rare, but for Kartagener syndrome (autosomal dominant characterized by ciliary dyskinesia and subfertility), it is seen in 25%. In partial situs inversus, the involvement may be either abdominal or cardiac.
Figure 4: The upper abdominal axial section demonstrates the mirror image positions of the abdominal viscera and heart in situs inversus totalis. The Liv and IVC are on the left side. The Sto, Spl, DesAo, and heart are on the right side. The superimposed drawing of the heart shows its axis toward the right anterior thorax (dextrocardia, with only 3%–5% incidence of congenital heart disease). The RA and RV are in the left side anterior thorax. GB, gall bladder; LA, left atrium; LV, left ventricle; Sp, spine, Sto: Stomach, Liv: Liver, IVC: Inferior vena cava, Spl: Spleen, DesAo: Descending aorta, RA: Right atrium, RV: Right ventricleThe heterotaxy syndromes include two main subtypes: (1). Bilateral left-sidedness (left atrial isomerism or polysplenia) and (2). Bilateral right-sidedness (right atrial isomerism or asplenia or Ivemark syndrome). Heterotaxy is suspected in the presence of dextrocardia, situs abnormality, complex cardiac anomalies such as hypoplastic ventricles, atrioventricular canal defect (AVCD), arrhythmias, venoatrial anomalies, pulmonary stenosis or atresia, and right aortic arch.[4]
Among the heterotaxy syndromes, the left atrial isomerism is more frequent than the right atrial isomerism. The prenatal diagnosis of left atrial isomerism is suggested by the duplication or mirror image of the left-sided structures with underdeveloped or absent right-sided structures. The presence of an interrupted IVC with azygos continuation (in 80%–90%.[5]), presence of a left superior vena cava (SVC), bilateral SVC, septal defects, and left ventricular outflow tract obstruction are common among these fetuses. Associated cardiac anomalies are less severe and rare compared to right atrial isomerism. AVCD is seen in 26%. Ipsilateral pulmonary venous return with right pulmonary veins draining into the right atrium and left pulmonary veins draining into the left atrium, DORV, and pulmonary stenosis are common with equal incidence in heterotaxy.[2] The detection of multiple small splenules and variations of bilateral atrial appendages are often difficult to define by antenatal ultrasonography.[6] Some features suggestive of left atrial isomerism are represented in [Figure 5].
Figure 5: Upper abdominal axial section shows left atrial isomerism (polysplenia). The symmetric Liv commonly occupies the left side. The Sto is on the right side but can be on the left-sided also. The Spl is visualized on the right side by the presence of the splenic hilar vessels. The inferior vena cava is interrupted above the level of the suprarenal and is connected to the dilated AzV or hemiazygos vein. This vein pierces the diaphragm and drains into the superior vena cava. The dilated AzV or HAzV is in front of the Sp and slightly posterior to the descending aorta. DesAo: “Double vessel sign.” Sp: Spine, Liv: Liver, Sto: Stomach, Spl: Spleen, AzV: Azygos vein, HAzV: Hemiazygos veinThe prenatal diagnosis of right atrial isomerism (asplenia) is suggested by the duplication or mirror image of the right-sided structures with underdeveloped or absent left-sided structures and associated major cardiac anomalies. Cardiac anomalies are seen in 50%–100%, of which AVCD is seen in 55%. The total anomalous pulmonary venous connection (TAPVC) also may be associated. DORV and pulmonary stenosis are common with equal incidence in heterotaxy.[2] A left SVC is present in 60% of these fetuses. Some ultrasound features are highlighted here [Figure 6]. Extracardiac anomalies are seen in 62%.
Figure 6: Upper abdominal axial section shows right atrial isomerism (asplenia). The symmetrically enlarged Liv occupies the midline or right-side upper abdomen. The Sto may be on the right or left side (position of the stomach alone is not diagnostic) or central. The spleen is absent in 74%–87%. The intact IVC and the DesAo are on the same side – “juxtaposition” in >80% (either on left or on right). Sp: Spine, Liv: Liver, Sto: Stomach, IVC: Inferior vena cava, DesAo: Descending aortaIn this case, the IVC is interrupted at the intra-hepatic level (suprarenal level) so that the venous return beyond this point is by the dilated hemiazygos vein which drains into the SVC [Figure 7].
Figure 7: Upper abdominal axial section shows interrupted inferior vena cava with hemiazygos continuation. The inferior vena cava is absent. Two vessels are seen in front of the Sp – “double vessel sign” with the dilated HAzV to the left of the DesAo. GB: Gall bladder, Liv: Liver, PorS: Portal sinus, Sp: Spine, Spl: Spleen, Sto: Stomach, UV: Umbilical vein, HAzV: Hemiazygos vein, DesAo: Descending aortaThe normal intra-abdominal venous communications are defined by a parasagittal plane using color Doppler. The abdominal part of the IVC is more anterior as it ascends cephalad. The ductus venosus is a narrow vessel that connects the umbilical vein with the subdiaphragmatic vestibulum of the IVC, which drains into the right atrium. The typical color aliasing of the ductus venosus makes it an easily identifiable vessel among others [Figure 8].
Figure 8: A para-sagittal color Doppler image shows normal intra-abdominal and lower thoracic veins. The UA, UV, (DV, arises from left portal vein marked by an arrow), IVC, and DesAo are seen in this plane. Diaph: Diaphragm, Ht: Heart, PV: Pulmonary veins, RHV: Right hepatic vein, RPoV: Right portal vein, Sp: Spine, UA: Umbilical artery, UV: Umbilical vein, DV: Ductus venosus, IVC: Inferior vena cava, DesAo: Descending aortaAn upper abdominal and lower thoracic parasagittal section can detect the absence of ductus venosus [Figure 9]. Abnormal ductus venosus flow and agenesis of ductus venosus are associated with increased association of cardiac and extracardiac anomalies.[7] The blood from the UV flows either into extrahepatic veins (IVC, iliac vein, SVC, right atrium, or coronary sinus) or into an intrahepatic venous network or into the right atrium.[8]
Figure 9: Upper abdominal and lower thoracic parasagittal section shows agenesis of ductus venosus. A narrow shunt (arrows) directly connects the UV with the IVC in the absence of the ductus venosus. Ht: Heart, LHV: Left hepatic vein, RPoV: Right portal vein, Sp: Spine, UV: Umbilical vein, IVC: Inferior vena cavaThe interrupted IVC at its intrahepatic part is drained by the dilated hemiazygos or azygos veins and gets connected to the SVC. The hepatic veins drain directly into the right atrium. These features are better defined in a parasagittal section of the upper abdomen and lower thorax [Figure 10]. Interrupted IVC is usually associated with other structural anomalies, especially with left atrial isomerism.
Figure 10: Abdominal and lower thoracic parasagittal section shows interrupted IVC with hemiazygos continuation (in left atrial isomerism). The position of the interrupted inferior vena cava is shown by asterisks. The hepatic veins RHV are connected directly to the right atrium. The HAzV which is dilated (size as of aorta, lying parallel and posterior to the aorta) shows flow towards the cranial end and the DesAo shows flow toward the caudal end. These vessels are positioned side by side – “double-vessel sign.” DV: Ductus venosus, PV: Pulmonary vein, RPoV: Right portal vein, Sp: Spine, UA: Umbilical artery, UV: Umbilical vein, HAzV: Hemiazygos vein, DesAo: Descending aorta, RHV: Right hepatic vein, Ht: Heart, Diaph: DiaphragmThe normal three major hepatic veins (right, middle, and left) are definable by an upper abdominal axial section through the liver. The hepatic veins join the IVC in the form of a “trident.”[9][Figure 11]. It continues as the subdiaphragmatic vestibulum and enters the right atrium after piercing the diaphragm.
Figure 11: Normal upper abdominal axial section through the liver just below the heart shows the hepatic veins (RHV, MHV, LHV: right, middle, and left hepatic veins) converging to form the inferior vena cava (IVC) on the right side, forming the “trident sign”. DesAo, descending aorta; Sp, spine; Sto, stomachIn TAPVC, the pulmonary veins drain either directly into the right atrium or into the systemic veins. It should be suspected when the pulmonary veins cannot be traced into the left atrium (four-chamber view) and a confluent vein is seen posterior to the left atrium. A wide gap is evident between the posterior left atrial wall and the descending aorta. The right atrium and the right ventricle are disproportionately enlarged (4-chamber view). The presence of a vertical vein in Type I (supracardiac type, which is common) appears as a fourth vessel (3-vessel trachea view). In partial anomalous pulmonary venous connections (PAPVC), at least one pulmonary vein drains into the left atrium and the other pulmonary veins drain directly or indirectly into the right atrium. These abnormal pulmonary venous connections are common in heterotaxy syndromes. The four types of TAPVC can occur. The most common is Type I (supracardiac, defined by 4CV and upper mediastinal axial sections). The other types are Type II (cardiac), Type III (infracardiac), and Type IV (mixed). Often there are associated cardiac and extracardiac anomalies in TAPVC. The features of some types are illustrated below. An upper abdominal axial section through the liver shows the presence of an anomalous pulmonary vein with an infra-diaphragmatic connection [Figure 12].
Figure 12: An upper abdominal axial section through the fetal liver shows total anomalous pulmonary venous connection/return (APVC, APVR) with infracardiac connection (Type III). A prominent anomalous pulmonary vein (APV) is seen posterior to the confluence of hepatic veins (RHV, MHV, LHV: right, middle and left hepatic veins). Color Doppler evaluation of this vessel will show the flow directed caudally in the same direction of descending aorta (DesAo). IVC, inferior vena cava; Sp, spineAn infracardiac TAPVC (Type III) is represented below with 3-dimensional (3D), color Doppler, and B-flow imaging which can better delineate the details [Figure 13] of the vertical vein.
Figure 13: An upper abdominal and lower thoracic parasagittal plane, 3D with color Doppler and B-flow shows TAPVC - infracardiac (Type III). In this fetus, the VV is coursing downward across the diaphragm almost parallel to the DesAo. DV: Ductus venosus, Ht: Heart, HV: Hepatic vein, UV: Umbilical vein, DesAo: Descending aorta, TAPVC: Total anomalous pulmonary venous connection, VV: Vertical veinThe most common form of PAPVC shows the right upper pulmonary vein connected to the right atrium or the SVC which is associated with a sinus venosus type of atrial septal defect (ASD) in the majority. The following case shows PAPVC involving the right inferior pulmonary vein [Figure 14].
Figure 14: Upper abdominal and thoracic, right parasagittal section shows PAPVC with scimitar syndrome (PAPVC with hypoplasia of right pulmonary artery and right lung). The RIPV appears as a curved sword (scimitar vein) which drains into the IVC. Diaph: Diaphragm, RA: Right atrium, Sp: Spine, PAPVC: Partial anomalous pulmonary venous connection, RIPV: Right inferior pulmonary vein, IVC: Inferior vena cavaAn upper abdominal and thoracic parasagittal view defines the normal major veins, interatrial septum, and the right pulmonary artery [Figure 15].
Figure 15: Normal upper abdominal and thoracic right para-sagittal bicaval view (Seagull wing view). The IVC and the SVC are in a straight line connected to the posterior aspect of the RA. The IAS separates the LA from the RA. The RPA is posterior to the RA. The EuV is seen at the wider junction of the IVC with the RA. The AzV drains into the SVC. DV: Ductus venosus, PV: Pulmonary vein, Sp: Spine, UV: Umbilical vein, IVC: Inferior vena cava, SVC: Superior vena cava, RA: Right atrium, IAS: Interatrial septum, LA: Left atrium, RPA: Right pulmonary artery, EuV: Eustachian valve More Details, AzV: Azygos veinSinus venosus ASDs account for only 10% among the various ASDs. This can be detected by a right parasagittal bicaval view [Figure 16].
Figure 16: Upper abdominal and thoracic, right para-sagittal bicaval view shows sinus venosus atrial septal defect of the superior vena cava. A discontinuity is seen at the junction of the SVC or IVC with the IAS. AzV: Azygos vein, DV: Ductus venosus, EuV: Eustachian valve, HV: Hepatic vein, IAS: Interatrial septum, LA: Left atrium, PV: Pulmonary vein, RA: Right atrium, RAAP: Right atrial appendage, RPA: Right pulmonary artery, Sp: Spine, UV: Umbilical vein, IAS: Interatrial septum, SVC: Superior vena cava, IVC: Inferior vena cavaA right parasagittal bicaval view can assess the presence or interruption of a supra-hepatic portion of the IVC and the presence or absence of right SVC [Figure 17]. Moreover, a four-chamber view will show a vessel posterior to the descending aorta (double-vessel sign) and a three-vessels view will show a dilated SVC into which the azygos vein drains.
Figure 17: Upper abdominal and thoracic right para-sagittal bicaval view shows the interrupted inferior vena cava with azygos continuation (normal position of IVC is marked by asterisks). The anterior hook-like structure is the morphological LAAp in left atrial isomerism. (Since the dilated azygos vein draining into the superior vena cava is more medially located, it is not visible in this plane.) The HV is directly connected to the RA. AzV: Azygos vein, DV: Ductus venosus, IAS: Interatrial septum, LA: Left atrium, PV: Pulmonary vein, RPA: Right pulmonary artery, Sp: Spine, UV: Umbilical vein, LAAp: Left atrial appendage, HV: Hepatic veins, RA: Right atriumThe longitudinal section of the aorta arch is routinely evaluated in detail to evaluate the possibility of hypoplasia or coarctation of the aorta [Figure 18].
Figure 18: Normal longitudinal aortic arch view in sagittal/longitudinal plane. The root of the aorta positioned between the atria arises from the central thorax. The AscAo curves posteriorly with a narrow-angle toward the spine (Candy cane or walking cane appearance). Three arterial branches arise from the aortic arch, namely BCA, LCC, and LSCA. AoAr: Aortic arch, DesAo: Descending aorta, IAS: Interatrial septum, Isth: Isthmus, LA: Left atrium, LBCV: Left brachiocephalic vein, RA: Right atrium, RAAp: Right atrial appendage, RBR: Right bronchus, RPA: Right pulmonary artery, Sp: Spine, AscAo: Ascending aorta, BCA: Brachiocephalic artery, LSCA: Left subclavian artery, LCC: Left common carotid arteryThe narrowing of ascending aortic diameter strongly indicates aortic coarctation.[10] The aortic arch will show reversal of flow resulting from ductus arteriosus shunt in hypoplastic left heart or mitral valve inflow obstruction by an atrial septal aneurysm. Coarctation of the aortic arch can occur at three levels in relation to the ductus. The first type is the preductal coarctation which involves the narrowing of the arch proximal to the insertion of the ductus [Figure 19]. This type is commonly detected among fetuses. The second type is ductal coarctation which involves the junction of the ductus with the aortic arch. The third type is the postductal coarctation which involves the part distal to the ductus insertion.[11] When it involves a longer segment of the aortic arch, it is called “tubular hypoplasia.” Coarctation of the aorta may be an isolated anomaly or associated with other major cardiac anomalies such as large ventricular septal defect, left-sided cardiac anomalies as in Shone syndrome, DORV, persistent left SVC, tricuspid atresia, double inlet ventricle/single ventricle, and corrected transposition of great arteries.[12]
Figure 19: Long axis view of the aortic arch shows CoA at the Isth between the AoAr and the DA. The narrowing at the junction of this isthmic region forms the “shelf sign.” AoAr: Aortic arch, AscAo: Ascending aorta, BCA: Brachiocephalic artery, DesAo: Descending aorta, IAS: Interatrial septum, LA: Left atrium, LBCV: Left brachiocephalic vein, RA: Right atrium, RA: Right atrium, RAAp: Right atrial appendage, RBr: Right bronchus, RPA: Right pulmonary artery, Sp: Spine, CoA: Coarctation of the aorta, AoAr: Aortic arch, DA: Ductus arteriosus, Isth: Isthmic regionCoarctation of the aortic arch involving the segment between the left common carotid artery and the left subclavian artery is shown in [Figure 20].
Figure 20: Long axis view of the aortic arch shows CoA between the LCCA and the LSCA. AoAr: Aortic arch, AscAo: Ascending aorta, BCA: Brachiocephalic artery, DesAo: Descending aorta, IAS: Interatrial septum, Isth: Isthmus, LA: Left atrium, LBCV: Left brachiocephalic vein, RA: Right atrium, RAAp: Right atrial appendage, RBr: Right bronchus, RPA: Right pulmonary artery, Sp: Spine, CoA: Coarctation of the aorta, LCCA: Left common carotid artery, LSCA: Left subclavian arteryThe complete discontinuity between the ascending and descending aorta characterizes the interruption of the aortic arch. This can occur at three levels along the arch in relation to the brachiocephalic arteries. Type A interruption is after the left subclavian artery, Type B interruption is between the left common carotid artery (most common) and left subclavian artery and Type C interruption is between the right brachiocephalic artery and left common carotid artery [Figure 21].
The ductal arch is evaluated by the sagittal and parasagittal sections. It arises from the main pulmonary artery which is more anterior in the chest and courses posteriorly without branching, unlike the aortic arch. The ductus arteriosus joins it with the descending aorta [Figure 22]. The ductal arch should be interrogated for its caliber, flow direction, aliasing, and velocity. Severe right-sided obstructive lesions such as pulmonary stenosis or atresia cause flow reversal in ductus arteriosus.
Figure 22: Normal longitudinal (sagittal) ductal arch view. The RV and the pulmonary artery root are more anterior in the thorax. In an oblique section, the AscAo is seen in the central thorax between the PA and LA. The PA bends and courses posteriorly like a “hockey stick” forming the DA. The ductus arteriosus gives off no branches and has the same caliber as the DesAo. It joins the AoI forming a “Y” shaped junction and continues as the descending aorta. The LPA originates from the pulmonary artery. Diaph: Diaphragm, PV: Pulmonary valve, Sp: Spine, RV: Right ventricle, AscAo: Ascending aorta, LA: Left atrium, PA: Pulmonary artery, DA: Ductus arteriosus, DesAo: Descending aorta, AoI: Aortic isthmus, LPA: Left pulmonary arteryThe parasagittal section of the ductal arch includes more details of the cardiac chambers and major arterial branches [Figure 23].
Figure 23: Normal longitudinal (parasagittal) ductal arch view. The LA, RA, TV, RV, and PA wrap Ao at the level of the aortic valve. The aorta is posterior to the RV and anterior to the LA roof. The LPA branches out from the main PA. DA: Ductal arch, DesAo: Descending aorta, Diaph: Diaphragm, PV: Pulmonary valve, Sp: Spine, LA: Left atrium, RA: Right atrium, TVL: Tricuspid valve, RV: Right ventricle, PA, Pulmonary artery, Ao: Around the aorta, LPA: Left pulmonary artery Conclusion An attempt to represent the normal and some typical abnormal fetal echocardiographic images by simplified sectional schemas is carried out. These will serve as the basic reference diagrams to correlate and interpret the fetal echocardiographic images. Since the schemas are made with the commonly used Microsoft Office Word (Drawing Canvas) using the mouse, the schemas can be used as templates when electronically transmitted. These figures can be used for the modification or addition by the readers.
The future upholds promises for better fetal cardiac imaging with the use of matrix probes, faster image reconstruction of 3D/4D images, improvements in STIC volume (spatio-temporal image correlation), and artificial intelligence.[13]
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References 
Correspondence Address:
Dr. Balakumar Karippaliyil
Balku's Scan, PVS Hospital, Kozhikode - 673 002, Kerala
India
Source of Support: None, Conflict of Interest: None
CheckDOI: 10.4103/apc.apc_4_22
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