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Abnormal Four-Chamber View

Example: Fig 1, Fig 2, Fig 3, Fig 4

 Septal defects (see specific cardiac anomalies)

Left ventricle smaller than right ventricle

  • Artifacts: inappropriate plane
  • Early congestive heart failure
  • Hypoplastic left heart syndrome (HLHS); the most common structural defect of small left ventricle
  • Coarctation or hypoplastic arch
  • Double-outlet right ventricle

Right ventricle smaller than left ventricle

  • Artifacts: inappropriate plane
  • Triscuspid atresia (common)
  • Pulmonary atresia
  • Hypoplastic right heart syndrome (HRHS)

Enlarged right atrium

  • Tricuspid regurgitation or stenosis
  • Coarctation of aorta (also enlarged right ventricle)
  • Ebstein’s anomaly

Enlarged left atrium

  • Mitral stenosis
  • Severe mitral regurgitation

Abnormal cardiac axis (an abnormal axis increases the risk of a cardiac anomaly)

  • Normal variation
  • Pressure effect (intrathoracic mass)
  • Intrinsic cardiac anomaly (especially hypoplastic heart syndrome)

Fig 1:  Atrioventricular canal  Four-chamber view: common atrium and ventricle, no visible central crux (arrow)

Fig 2:  Ebstein anomaly  Four-chamber view: enlarged atrium (solid circle) with low attachment of tricuspid valve (*)

Fig 3:  Atrioventricular canal  Four-chamber view: common atrium and ventricle, no visible central crux (arrow)

Fig 4:  Hyperthrophic cardiomyopathy  Four-chamber view: marked cardiomegaly, thickened interventricular septum (*) and echogenic endocardium (arrow)

Video clips of abnormal four-chamber view

Endocardial cushion defect:  Four-chamber view: atrial and ventricular septal defect, arrowhead = spine

Large ventricular septal defect:  Four-chamber view: incomplete interventricular septum (*), (arrowhead = spine)

Atrial septal defect:  Four-chamber view: abnormal cardiac axis, no atrial septum seen (arrowhead = spine)

Ebstein’s anomaly:  Ebstein’s anomaly in case of corrected transposition of the great artery: Low insertion of the tricuspid valve (TV) of the left-sided right ventricle (IVS = interventricular septum)

Cardiomyopathy:  Marked cardiomegaly with thickening of the interventricular septum (IVS) and poor contractility