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Five Transverse View of the Fetal Heart

In 2013, The International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) published updated practice guidelines for screening of the fetal heart, suggesting early detection rates can be optimized by performing a thorough examination of the fetal heart by complementing the four-chamber view with the outflow tract views in the cardiac screen, thus totaling five transverse views. This recommendation supports the educational outreach and sonographer training program led by Helena Gardiner, M.D., Ph.D.

Understanding the five transverse views

five_transverse_viewThe image is representative of the five axial views for optimal fetal heart screening. The color image shows the trachea (Tr), heart and great vessels, liver and stomach, with the five planes of insonation indicated by polygons corresponding to the gray-scale images, as indicated.

  1. Most caudal plane, showing the fetal stomach (St), cross-section of the descending aorta (dAo), spine (Sp) and liver (Li).
  2. Four-chamber view of the fetal heart, showing the right and left ventricles (RV, LV) and atria (RA, LA), foramen ovale (FO) and pulmonary veins (PV) to the right and left of the dAo.
  3. Left ventricular outflow tract view, showing the aortic root (Ao), LV, RV, LA and RA and a cross-section of the dAo.
  4. Slightly more cephalad view (right ventricular outflow tract view) showing the main pulmonary artery (MPA) and the bifurcation into the right (RPA) and left (LPA) pulmonary arteries and cross-sections of the ascending aorta (Ao) and dAo aorta.
  5. Three vessels and trachea view showing the superior vena cava (SVC), pulmonary artery (PA), ductus arteriosus (DA), transverse aortic arch (from proximal Ao to dAo) and trachea (Tr). IVC, inferior vena cava; L, left; R, right. Modified with permission from Yagel et al.
Image provided by the International Society of Ultrasound in Obstetrics and Gynecology. Yagel S, Cohen SM, Achiron R. Examination of the fetal heart by five short-axis views: a proposed screening method for comprehensive cardiac evaluation. Ultrasound Obstet Gynecol 2001; 17: 367–369