Arch Gynecol Obstet (2008) 278:387–391 DOI 10.1007/s00404-008-0597-4 123 CASE REPORT Prenatal diagnosis of Ebstein’s anomaly using spatio-temporal image correlation (STIC) and inversion mode Edward Araujo Júnior · Luiz Cláudio de Bussamra · Fernanda Silveira Bello Barros · Ingrid Schwach Werneck Britto · Tsutomo Aoki · Claudio Rodrigues Pires · Paulo Martin Nowak · Luciano Marcondes Machado Nardozza · Antonio Fernandes Moron Received: 30 November 2007 / Accepted: 4 February 2008 / Published online: 20 February 2008  Springer-Verlag 2008 Abstract Background Ebstein’s anomaly is a rare cardiac defect where the septal and posterior leaXets are displaced, towards the right ventricle. The leaXets are dysplastic and stuck to the ventricular wall. Its antenatal diagnosis is usually made through bidimensional echocardiography, which also has prognostic value. Recently, the technological breakthrough of three-dimensional ultrasound (3D-US) oVered new diag- nostic tools for congenital heart defects, less dependent on the ultrasonographer experience, when compared to two- dimensional ultrasound (2D-US). The spatio-temporal image correlation (STIC) technique allows the acquisition of the fetal heart volume and its structures as a 4D cineloop sequence showing the complete cardiac cycle. Inversion mode is a new image analysis tool for the examination of Xuid-Wlled fetal structures that inverts the gray scale. Case report We present a case of Ebstein’s anomaly diag- nosed at 26 weeks of pregnancy through bidimensional echocardiography. We emphasize its main Wndings in 3D- US using the STIC and inversion mode techniques. Keywords Prenatal diagnosis · Congenital heart disease · Echocardiography · Three-dimensional ultrasound Introduction Ebstein’s anomaly is a rare congenital heart defect with a prevalence of 0.3–0.6% of all cardiac malformations [1]. This defect is characterized by a variable degree of dis- placement of the tricuspid valve leaXets towards the right ventricle [2]. Due to the shift in the tricuspid valve there is the formation of an entry zone between the atrioventricular junction and the leaXets named atrialized portion, with a thinner wall than the muscular area [2]. The leaXets are dys- plastic and stuck to the right ventricle wall. [3]. Antenatal diagnosis is usually obtained by fetal bidimen- sional echocardiography [4]. The four-chamber view, made in routine obstetric ultrasound exams, presents a high sensi- bility for Ebstein’s anomaly suspicion, and a further screen- ing through an echocardiography [5]. The main Wndings for this pathology seen in the echocardiography are: displace- ment of the tricuspid valve leaXets, atrialized zone in the right ventricle, right ventricle insuYciency, cardiomegaly, tricuspid valve regurgitation, ventricular septal defect and atrial septal defect [6]. Bidimensional ultrasound (2D-US) is the technique of choice for congenital heart defects screening, but it presents some limitations as: operator dependent exam, fetal posi- tion, oligohydramnios, real time exam, and time consuming image acquisition [7]. Three-dimensional ultrasound (3D-US) depends less in the operator when used to evaluate the fetal heart. E. Araujo Júnior · L. C. de Bussamra · C. R. Pires · P. M. Nowak · L. M. M. Nardozza · A. F. Moron Department of Obstetrics, São Paulo Federal University (UNIFESP-EPM), São Paulo, SP, Brazil C. R. Pires Ultrasound Training Center of São Paulo (CETRUS), São Paulo, SP, Brazil L. C. de Bussamra · F. S. B. Barros · I. S. W. Britto · T. Aoki Department of Gynecology and Obstetrics, Medical Science College of Santa Casa of São Paulo (FCMSCSP), São Paulo, SP, Brazil E. Araujo Júnior (&) Rua Carlos Weber, 950 apto. 113 Visage, Alto da Lapa, São Paulo CEP 05303-000, SP, Brazil e-mail: araujojred@terra.com.br