Intracardiac echogenic focus: Its importance during routine prenatal ultrasound screening in a black African population

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.