Examination of the fetal heart is usually done by means of echocardiography at 18 weeks of gestation or later. Prior to that time, the fetal heart is usually too small to accurately assess. There are many reasons for a fetal echocardiogram to be recommended by one's obstetrician.

Fetal Cardiology

Some maternal diseases, such as diabetes, can lead to an increased risk of heart disease in the fetus. Although the risk for any child to have heart disease is about one percent, there is an increased risk if either parent or a sibling has had any type of congenital heart disease. Therefore, your obstetrician will likely recommend a fetal echo be performed if there is a family history of congenital heart disease. Various medications a mother might have taken during the pregnancy can also contribute to heart disease in the fetus. Certain "syndromes" diagnosed in a fetus can also be associated with congenital heart disease.

During a routine fetal ultrasound, it is usual for the "four chamber view" of the heart to be imaged. The top two chambers (the atria) of the heart should both look equal in size. Likewise, the bottom two pumping chambers (the ventricles) should also appear similar in size. During some fetal ultrasounds, the four chamber view may not be completely seen or one of the chambers may not look equal in size to the others. In these situations, an obstetrican may also recommend that a fetal echo be performed. The obstetric physician also listens carefully to the fetal heart beat on every prenatal examination. If an abnormal heart beat (arrythmia) or heart rate is detected, fetal echocardiography will likely be suggested.

During a fetal echo, all four of the heart's chambers and valves are examined. In addition, both of the major blood vessels (the aorta and pulmonary artery) which leave the heart are imaged. The major veins which bring blood back to the heart are also examined. Doppler echo will be performed to determine the direction and speed of the blood flow in the heart. An evaluation for fetal arrythmias will also be performed.

If the fetal echocardiogram reveals an abnormality, various other evaluations or treatment will be suggested. For some types of fetal arrythmias and congenital heart disease, no specific treatment may be necessary. In other cases, frequent reevaluation of the fetus may be required. In rare cases, medication may be prescribed for the mother. Because of the special physiology of the fetal heart and lungs, most fetuses can tolerate even severe forms of congenital heart disease (CHD). Problems may be noted only after the baby is delivered. For that reason, mother's of fetuses with some types of CHD may need to deliver their infants at centers capable of immediately delivering the specialized care that these children require.

Once the fetal echocardiogram has been performed, Dr. Alenick will discuss the results of the test with you in detail. If required, he may suggest further reevaluation or specific treatment.