Intracardiac echogenic focus: Its importance during routine prenatal ultrasound screening in a black African population
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Abstract
Background: Intracardiac echogenic focus (ICEF) is defined as a small bright structure within the fetal heart with similar or greater echogenicity to the surrounding bone. The cause of ICEF is unknown, although it is generally believed to be a normal variant. However, several authors have reported a possible association between an ICEF and chromosomal abnormalities, while some others have found an association with structural cardiac anomalies. There are presently no data on this subject in sub-Saharan Africa about the possible correlation with other anomalies.
Materials and Methods: This was a prospective, cross-sectional, hospital-based study in a native West African population that spanned 5 years and 5 months. All the pregnant women who presented for routine prenatal ultrasound screening for fetal anomaly between 18 and 22 weeks’ gestation age during the study period were included in the study. The prevalence and pattern of ICEF and correlations with cardiac anomalies were determined.
Results: In this study, 1.986 fetuses were evaluated for ICEF. The prevalence of ICEF was 2.2%, and more commonly (38.6%) seen in fetuses of mothers aged 30–34 years. Twenty-five percent (25%) occurred in fetuses of mothers that are older than 35 years. Most cases (65.7%) occurred in mothers that had no risk factors for the cardiac anomaly. Majority of the ICEF were solitary and within the left ventricle (95.5% and 93.2%, respectively). About 2.3% of the ICEF were biventricular. Among those that had further echocardiographic evaluation, 15% had major structural cardiac defects.
Conclusion: A left ventricular ICEF may not indicate a normal variant in all cases. We propose the addition of detailed fetal echocardiography to rule out structural cardiac anomalies.
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1. Schechter AG, Fakhry J, Shapiro LR, Gewitz MH. In utero thickening of the chordae tendinae. A cause of intracardiac echogenic foci. J Ultrasound Med 1987;6:691‑5.
2. Marton U, Stipoljev F, Kos M, MiKovi B, Matijevi R, Kurja A. The value of the intracardiac echogenic foci in the fetal heart: current
understanding and clinical values. Gynaecol Perinatol 2003;12:154‑6.
3. Brown DL, DiSalvo DN, Frates MC, Doubilet PM, Benson CB, Laing FC, et al. Sonography of the fetal heart: Normal variants and pitfalls. AJR Am J Roentgenol 1993;160:1251‑5.
4. Mirza FG, Ghulmiyyah L, Tamim H, Bou Hamdan F, Breidy J, Geagea S, et al. Echogenic intracardiac focus on second trimester ultrasound: Prevalence and significance in a Middle Eastern population. J Matern Fetal Neonatal Med 2016;29:2293‑6.
5. Rebarber A, Levey KA, Funai E, Monda S, Paidas M. An ethnic predilection for fetal echogenic intracardiac focus identified during targeted midtrimester ultrasound examination: A retrospective review. BMC Pregnancy Childbirth 2004;4:12.
6. Levy DW, Mintz MC. The left ventricular echogenic focus: A normal finding. AJR Am J Roentgenol 1988;150:85‑6.
7. Shipp TD, Bromley B, Lieberman E, Benacerraf BR. The frequency of the detection of fetal echogenic intracardiac foci with respect to
maternal race. Ultrasound Obstet Gynecol 2000;15:460‑2.
8. Bromley B, Lieberman E, Shipp TD, Richardson M, Benacerraf BR. Significance of an echogenic intracardiac focus in fetuses at high and low risk for aneuploidy. J Ultrasound Med 1998;17:127‑31.
9. Petrikovsky BM, Challenger M, Wyse LJ. Natural history of echogenic foci within ventricles of the fetal heart. Ultrasound Obstet Gynecol
1995;5:92‑4.
10. Barsoom MJ, Feldman DM, Borgida AF, Esters D, Diana D, Egan FX. Is an isolated fetal cardiac echogenic focus an indication for fetal echocardiography? J Ultrasound Med 2001;20:1043‑6.
11. Wolman I, Jaffa A, Geva E, Diamant S, Strauss S, Lessing JB, et al. Intracardiac echogenic focus: No apparent association with structural
cardiac abnormality. Fetal Diagn Ther 2000;15:216‑8.
12. Nyberg DA, Souter VL. Sonographic markers of fetal trisomies: Second trimester. J Ultrasound Med 2001;20:655‑74.
13. Bhagwat AR. Significance of Echogenic Cardiac Nodule in Fetus. Int J Anat Radiol Surg 2017;6:RO64‑7.
14. Sepulveda W, Cullen S, Nicolaidis P, Hollingsworth J, Fisk NM. Echogenic foci in the fetal heart: A marker of chromosomal abnormality. Br J Obstet Gynaecol 1995;102:490‑2.
15. Guo Y, He Y, Gu X, Zhang Y, Sun L, Liu X, et al. Echogenic intracardiac foci and fetal cardiac anomalies: A review of cases from a tertiary care
center in China. J Clin Ultrasound 2018;46:103‑7.
16. Bronshtein M, Jakobi P, Ofir C. Multiple fetal intracardiac echogenic foci: Not always a benign sonographic finding. Prenat Diagn 1996; 16:131‑5.
17. Coco C, Jeanty P, Jeanty C. An isolated echogenic heart focus is not an indication for amniocentesis in 12,672 unselected patients. J Ultrasound
Med 2004;23:489‑96.
18. Simpson JM, Cook A, Sharland G. The significance of echogenic foci in the fetal heart: A prospective study of 228 cases. Ultrasound Obstet
Gynecol 1996;8:225‑8.
19. Carriço A, Matias A, Areias JC. How important is a cardiac echogenic focus in a routine fetal examination? Rev Port Cardiol 2004;23:459‑61.
20. Lehman CD, Nyberg DA, Winter TC 3rd, Kapur RP, Resta RG, Luthy DA. Trisomy 13 syndrome: Prenatal US findings in a review of 33 cases. Radiology 1995;194:217‑22.
21. Winter TC, Anderson AM, Cheng EY, Komarniski CA, Souter VL, Uhrich SB, et al. Echogenic intracardiac focus in 2nd‑trimester fetuses with trisomy 21: Usefulness as a US marker. Radiology 2000;216:450‑6.
22. Vibhakar NI, Budorick NE, Scioscia AL, Harby LD, Mullen ML, Sklansky MS. Prevalence of aneuploidy with a cardiac intraventricular echogenic focus in an at‑risk patient population. J Ultrasound Med 1999;18:265‑8.
23. Manning JE, Ragavendra N, Sayre J, Laifer‑Narin SL, Melany ML, Grant EG, et al. Significance of fetal intracardiac echogenic foci in relation to trisomy 21: A prospective sonographic study of high‑risk pregnant women. AJR Am J Roentgenol 1998;170:1083‑4.