Fetal heart: a 4-chamber view is not enough.

The majority of children born with congenital heart disease have no identifiable risk factors and, therefore, prenatal diagnosis relies on routine ultrasonographic screening. First proposed in 1985, the 4-chamber view is a component of the basic fetal cardiac examination. However, many life-threatening conditions (eg, transposition of the great arteries) can present with a normal 4-chamber view and may only be detected by systematic evaluation of the outflow tracts. Although this is a technically challenging skill, its mastery is a worthwhile goal of ultrasonography training, as it likely to improve the lives of at least some of the children affected by the most severe forms of congenital heart disease.