1. What are focal strong echoes in the heart? Focal strong echoes within the heart are not congenital heart disease and are not associated with myocardial dysfunction. It is usually associated with microcalcifications and fibrosis of the papillary muscles or tendons of the heart. 2.When does it appear? When does it disappear? Intracardiac focal strong echoes can be seen as early as 11-14 weeks of gestation during NT ultrasound, and most of them are found during 20-24 weeks of gestation during platysmal ultrasound, and they usually disappear in late pregnancy, and a few of them disappear after delivery. 3. What is the manifestation of focal strong echo in the heart? It usually appears as a single focal spot in the left ventricle, but it can also appear as a multifocal spot, a biventricular focal spot or a spot in the right ventricle only. The diagnostic criteria for ultrasound is brightness comparable to bone. 4. What is the significance? The fear of focal intracardiac echoes stems from the finding that 21-28% of fetuses with Down syndrome have focal intracardiac echoes during mid-term pregnancy, compared to 3%-5% of normal fetuses. Therefore, strong ventricular echoes have previously been used as one of the soft ultrasound indicators. However, subsequent studies have found that the rate of presence of intracardiac focal strong echoes varies between racial/ethnic groups, and in our Asian population, the rate is as high as 30% in fetuses and decreases with increasing gestational age. Therefore, at present, for the Asian population, ventricular focal strong echoes, are no longer used as an ultrasound soft indicator. 5. Do I need an amniocentesis with intracardiac focal strong echoes? The best available evidence suggests that in the absence of other risk factors, intracardiac focal strong echoes alone do not increase the risk of aneuploidy. If fetuses with otherwise normal midterm pregnancies are found to have intracardiac focal strong echoes, a low risk result on noninvasive DNA screening can be quite reassuring and does not require invasive testing, i.e., amniocentesis. 6. Is there a relationship between the number and location of intracardiac echoes and the risk of chromosomal abnormalities? Although some studies have reported that the location or number of focal strong echoes affects the risk of fetal aneuploidy, and it is thought that the risk is higher with biventricular or right ventricular involvement, it is generally agreed that there is insufficient evidence for the effect of these factors. 7. Do I need a fetal echocardiogram (cardiac ultrasound)? Focal strong echoes in the ventricles are not malformations of the fetal heart and do not suggest abnormal cardiac function, so fetal cardiac ultrasound is not required.