Q: I am years 24 years old and underwent an ultrasound at 18 weeks of my pregnancy. Everything seems fine except that the sonographer found a white spot in the fetal heart. The doctor says that it is due to calcification in the heart. Since my blood tests were good, she said that it is a minor issue and the spot might go away by my next ultrasound. However, she recommended to go for a second ultrasound in two weeks to take a good look at the spot. I am so worried about this. What is meant by calcification of the heart? How badly can it affect my baby?

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.