Sonographic detection of fetal anomalies of the aortic and pulmonary arteries: value of four-chamber view vs direct images.

Some investigators support the notion that the four-chamber view of the fetal heart is sufficient for the sonographic identification of most serious heart defects [1, 2]. We have found that the evaluation of the great vessels (aorta and pulmonary artery) is crucial for the detection of some of the most common heart defects, such as tetralogy of Fallot and transposition of the great arteries [3-5]. Although many abnormalities of the great vessels can be recognized indirectly by an abnormal four-chamber view, the detection of the ductus-dependent lesions often requires evaluation of the aorta and pulmonary artery outflow tracts [3-5]. This pictorial essay illustrates abnormalities of the great vessels and shows those likely to be identified with a four-chamber view as opposed to those that require direct images of the great vessels for detection.