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Cardiology

The pediatric cardiologists at the Perinatal Center are dedicated to pre-natal and post-natal diagnosis, management, and treatment of congenital heart disease. We offer the full range of innovative diagnostic and treatment services, including a state-of-the-art digital echocardiography laboratory.

Fetal Echocardiography

We are pleased and honored to participate in the care of your family. We fully appreciate the anticipation and anxiety that comes with your preparation for parenthood and pledge to do our best to offer you the highest quality diagnostic imaging and consultation in an efficient and compassionate manner. In preparation for your visit, we offer some helpful information about Fetal Echocardiography.

What is a Fetal Echocardiogram?

A fetal echocardiogram is an ultrasound examination of the fetal heart. Ultrasound is performed by passing sound waves from a special camera, called a transducer, then recording the echoes that return to the transducer after reflecting off of structures in the body. Fetal echocardiography provides moving pictures of the cardiac chambers and valves as well as the larger blood vessels that carry blood to and from the heart. Fetal Echocardiography can be performed any time after the 16th week of pregnancy, but imaging is usually best between the 18th and 22nd week.

Why is a fetal echocardiogram needed?

A fetal echocardiogram can identify many of the more significant birth defects that can affect a child's heart. Early diagnosis of a serious condition can allow the opportunity to plan the remainder of the obstetrical care, to choose the method and location of birth, and to anticipate and prepare for the immediate needs of the baby after birth.

A fetal echocardiogram is not a routine part of usual obstetrical care, but is commonly requested whenever there is reason to suspect a higher than usual chance of a congenital heart defect. A fetal echocardiogram could be requested under cirumstances that include:

• History of congenital heart disease in a family member of the fetus
• Suspicion of an abnormality in the heart during a routine obstetrical ultrasound study, or inability to see the heart adequately on an obstetrical ultrasound study
• Observed abnormality in the fetal heart rate or rhythm
• Observed abnormality in another major organ such as the kidney or limbs
• Exposure to an infection, medication, or environmental agent that may result in a heart abnormality
• An abnormal amount of fluid in the fetal (amniotic) sac
• Diabetes, either during pregnancy or preceding pregnancy
• Any test, including amniocentesis, that suggests an abnormality of the chromosomes, such as Down Syndrome

Remember, though, that for each of these valid reasons to perform a Fetal Echocardiogram, the baby's heart is still usually normal. The confirmation of normal fetal heart structure and function by fetal echocardiography provides reassurance to continue the pregnancy without the concern of fetal heart disease.

Fetal Echocardiograms and Arrhythmias

Fetal echocardiography may be used to diagnose fetal arrhythmias (heart rhythm abnormalities). In addition to providing information on the structure of the fetal heart, various measurements are used to differentiate the types of heart rhythm abnormalities. These can range from an irregular heartbeat to tachyarrhythmias (fast heart rhythms), bradyarrhythmias (slow heart rhythms) or various types of heart block (slowed or blocked electrical conduction in the heart). There are certain maternal conditions such as lupus, hyperthyroidism or long QT syndrome that may pre-dispose a fetus to an arrhythmia. In other instances, your obstetrician may detect an abnormality of fetal heart rate or rhythm and refer you to a perinatal cardiologist for further evaluation.

What happens if my child is diagnosed with a congenital heart problem?

Many congenital heart abnormalities do not significantly impact an individual's health, particularly in infancy or early childhood. If one of these conditions is diagnosed on the fetal echocardiogram, you will learn about the problem and establish a relationship with a Perinatal Center pediatric cardiologist who will follow your child's condition through childhood.

In the case of severe abnormalities that may significantly affect the fetus or infant, a Perinatal Center cardiologist and your obstetrician will discuss with you a suitable plan for your pregnancy and delivery. If there is the potential for illness around the time of birth, you will have the opportunity to consult with the staff of the Neonatal Intensive Care Unit. In the event of a condition that may require surgery in the period shortly after birth, you will have the opportunity to consult in advance with Dr. Jonathan Chen, Chief of the Division of Pediatric Cardiothoracic Surgery, who will perform the operation after the birth of your baby.

Certain abnormalities of the heart rate and rhythm can be treated by administering medications to you, the mother. Our pediatric cardiologist and the high-risk obstetrics team will carry out this course of action.

What are the limitations of Fetal Echocardiography?

Some congenital defects may not be detected on a fetal echocardiogram. For example,

• Certain congenital cardiac defects can escape detection due to the nature of the fetal circulatory system, which will change significantly after the baby's birth. The Fetal Echocardiogram can only show the prenatal circulation and cannot demonstrate the changes that will occur months later at delivery.
• Small holes between the two lower chambers of the heart (ventricular septal defect) cannot be entirely ruled out on fetal echocardiography, and are often identified by a characteristic heart murmur in infancy. These rarely cause any clinical problem or require correction.
• Because there is little blood flowing into and out of the fetal lungs, abnormalities in the veins from the lungs can escape detection, although with current technology, significant abnormalities in these lungs can usually be ruled out by the fetal echocardiogram.