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A.
The white spot in the heart refers to calcification of the papillary muscle. This is not an infrequent finding and is usually of no significance, either in the life of the baby within the womb or after birth. There is no doubt, however, that fetuses with Down's Syndrome, which is a chromosomal abnormality (Trisomy 21) associated with mental and physical disabilities, show an increased incidence of this echogenic intracardiac focus. For this reason the finding becomes significant in a high risk group. This group includes a maternal age above 35 years, abnormal results from a biochemical screening for this condition between 11-20 weeks of gestation, a sibling with Trisomy 21 or a fetus with any other ultrasound sign of this condition. This group needs to be counselled about the need for an amniocentesis which is more accurate than ultrasound, and consists of obtaining fluid that surrounds the baby in the womb and analysing cells that are obtained by cultivating this fluid in a laboratory. The test is reasonably safe and reasonably accurate. In the absence of any other abnormal feature on ultrasound and a negative family history of high risk and a normal fatal echocardiography, the finding does not warrant further action.
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