Fetal left ventricular punctate echo is an ultrasound manifestation that is usually caused by calcification of the papillary muscles of the heart or by calcification of the tendons. This is not a sign of congenital heart disease, nor does it indicate any impairment of fetal myocardial function, so there is no need to be nervous. In the past, fetal strong left ventricular echo was used as a soft indicator of ultrasound. Soft indicators of ultrasound refer to some special manifestations that suggest possible chromosomal abnormalities in the fetus. There is a correlation between fetal strong left ventricular echo and Down’s syndrome, and the incidence of strong left ventricular echo is higher in fetuses with Down’s syndrome. However, strong left ventricular echoes are also seen in normal fetuses, especially in Asian fetuses, where strong left ventricular echoes may be found in 30% of fetuses, so it is no longer considered a soft indicator of ultrasound for the Asian population. If non-invasive DNA or Down’s syndrome screening indicates a low risk and there are no other structural abnormalities, there is usually no need to be concerned about strong fetal left ventricular echoes or to be nervous about having a fetal heart ultrasound to see if there is a fetal heart problem.