• B W Zhao, Y Yang, M Pan, P Li, B Wang, and F G Tang.
• Department of Diagnostic Ultrasound and Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University Medical College, Hangzhou, China. zbwcjp@163.com
• Ultrasound Obstet Gynecol. 2010 May 1;35(5):548-51.

ObjectiveTo evaluate echocardiographic characteristics and clinical relevance of color Doppler twinkling artifacts in fetuses with isolated echogenic intracardiac foci (EIF).MethodsThis study included 50 fetuses with EIF, at 18-38 weeks of gestation. Echocardiographic examination, which was performed using a 1.0-5.0-MHz phased array probe, included gray-scale, color and spectral Doppler imaging. Twinkling artifacts were assessed using fetal color Doppler echocardiography on isolated EIF situated in the left and/or right ventricles. The prevalence, appearance and clinical relevance of the color Doppler twinkling artifacts were analyzed.ResultsEight of 50 fetuses with EIF (16%) showed color Doppler twinkling artifacts, which appeared as a rapidly changing color complex seen persistently behind the EIF. The spectra obtained in all eight with color Doppler artifacts were composed of straight vertical bands occurring in mid to late systole and early diastole. After birth, none of 50 fetuses with EIF had structural heart diseases or showed clinical signs of cardiac failure.ConclusionsColor Doppler twinkling artifacts from isolated EIF occur in some fetuses and may be considered as an additional echocardiographic feature of EIF. Attention should be paid to the identification and interpretation of these artifacts so that they may be accurately distinguished from true color flow generated by atrioventricular valvular regurgitation jets.Copyright 2010 ISUOG. Published by John Wiley & Sons, Ltd.

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