ICEF Origin

• The exact cause of intracardiac echogenic foci remains unclear; however, they appear to be caused by small deposits of calcium in the papillary muscle of the fetal heart. The condition may also be the embryologic result of incomplete fenestration of the chordate tendineae, or excessive thickening of the papillary muscle. Furthermore, abnormal development of the microvasculature may also be a contributing factor, and may potentially lead to early ischemic changes in the papillary muscle. There does not appear to be a correlation between ICEF formation and the maternal age, parity, gestational age or fetal weight. However, maternal age can be a contributing risk factor for chromosomal changes, especially when an ICEF is detected.
  
  

ICEF Description

• Intracardiac echogenic foci are typically 1 to 4 millimeters in diameter, but can be as large as 18 millimeters. When observed sonographically, they are described as peas, bright reflectors, bright spots or golf balls, reflecting the fact that they appear as white as bone. ICEF have been sonographically detected in 0.5 to 20 percent of fetuses during the second and third trimester, with an overall frequency of 5.6 percent. They generally form in the left ventricle and occasionally in the right ventricle or bilaterally. Intra-atrial or diffuse ICEF development is rare.
  
  

ICEF Persistence

• The persistence of neonatal intracardiac echogenic foci into childhood and its significance is not well established, due to a lack of data. However, available postnatal echocardiograms indicate that these foci do persist in the majority of cases, with only a 44 percent resolution rate at the neonatal level. Despite the general persistence of ICEF, they are not generally associated with childhood myocardial dysfunction.
  
  

ICEF Significance

• The detection of multiple echogenic foci or diffuse echogenicity in the fetal heart, especially when the right ventricle is effected, has been linked to other pathologies and may be an indicator of a more serious and significant diagnosis. The calcium deposits may also be an indication of damage to the myocardium and may be linked to potential cardiac diastolic dysfunction.
  
  Cardiac echogenic foci have been associated with cardiac tumors, congenital heart malformations and chromosomal abnormalities. However, the exact nature of this correlation remains unclear and warrants further studies. It has been observed that, when associated with other risk factors, ICEF may indicate a higher chance of a fetus having a chromosomal change, such as Down syndrome. In these cases, further testing, such as amniocentesis, is recommended. However, in the chromosomally normal fetus, ICEF are not associated with congenital heart defects.