4- chamber View and Situs: Normal and Common Abnormalities

Congenital heart anomalies (CHDs) are one of the most common forms of congenital anomalies and are responsible for about 40% of perinatal deaths. 4-chamber view is the most important plane for evaluation of the main cardiac structures, the position, the size, the cardiac axis, the contractility, and the rhythm of the heart. The detection rate of this view is about 69% for all complex heart anomalies. Some CHDs as conotruncal anomalies can’t be evaluated by this view. The image should be magnified and the cine-loop function should be used to analyze phases of the heart cycle. Inadequate examination is likely to be the most common cause of heart defects being overlooked in this view. The heart should ideally be assessed between 20 and 22 weeks› gestation. For increasing detection rate, teaching should not only include how to obtain this plane but it should also focus on the patterns of detectable anomalies. We should know, not all heart defects are already present in 1st or 2nd trimester; they may develop in utero later