The objective of our study was to determine the significance of antenatally detected, small hyperechoic foci in the fetal cardiac ventricle. In a 13-month period, we identified 25 fetuses with such a finding, an incidence rate of 0.46%. The hyperechoic foci in 24/25 fetuses were seen during follow-up serial scans. The size ranged from 1 to 6 mm. All had a normal fetal echocardiogram at 20-22 weeks' gestation. Eleven of the 24 neonates had a normal postnatal echocardiogram in the first 4 weeks of birth. One neonate had a previously undiagnosed transposition of the great vessels and no residual hyperechoic focus. Twelve had an echogenic focus located at the level of the chordae tendineae and papillary muscles in the left ventricle. In each of these 12 neonates, there was normal ventricular function determined by measuring the shortening fraction, and a competent atrioventricular valve. When hyperechoic foci are identified, baseline antenatal echocardiography should be performed to confirm their benignity. With an otherwise normal fetal and clinical neonatal evaluation, serial antenatal and confirmatory postnatal echocardiography are unnecessary. A possible relationship to other cardiac anomalies or aneuploidies requires further study.