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Detecting Congenital Heart Problems ASAP

New York, NY (Nov 24, 2009)

Fetal echocardiography, which uses sound waves to reveal the structure and function of an unborn baby's heart, has been around for many years. The technology for this non-invasive test has significantly improved since it was first introduced.

"With the latest technology, we can now obtain such detailed images of the fetal heart," says Sheila J. Carroll, M.D., F.A.A.P, F.A.C.C., Director of Fetal Cardiology at the Phyllis and David Komansky Center for Children's Health at NewYork-Presbyterian Hospital/Weill Cornell Medical Center, "that we are able to determine if there is significant congenital heart disease and, if so, immediately begin making plans for medical or surgical interventions after the baby is born-including those we may need to perform within hours after birth."

When is this test necessary?

If an obstetrician identifies a possible heart abnormality in the fetus during a routine ultrasound or if there's a problem getting a clear image of the heart, the patient is referred to a pediatric cardiologist for a fetal echocardiogram. The test can also be necessary for several other reasons. For example, if:

  • there's a family history of congenital heart disease
  • the mother has taken certain medications that could cause congenital heart disease
  • it has been discovered that the fetus has a genetic or chromosomal abnormality
  • the mother has abused alcohol or drugs during pregnancy
  • the mother has diabetes, phenylketonuria, or a connective tissue disease, or had rubella during the pregnancy

How early in the pregnancy should it be performed?

The optimal time for a fetal echocardiogram is between the 19th and 22nd week of pregnancy. It can be performed earlier, but the small size of the fetus makes it more difficult to get a good image of the heart.

How is a fetal echocardiogram performed?

A pediatric cardiologist or pediatric echo technician performs a fetal echocardiogram, using an abdominal ultrasound. A gel is applied to the abdomen and the ultrasound transducer glides over the abdomen to create the image with sound waves.

What happens if a heart problem is detected?

The good news is that a majority of the fetal echocardiograms reveal normal fetal hearts. If there is a congenital heart defect, the fetal echocardiogram usually reveals it—although there are a few heart abnormalities that cannot be detected before birth, including abnormalities that are related to changes in the fetal circulation that occur after birth.

If a heart defect is detected, the pediatric cardiologist who performed the fetal echocardiogram at the Komansky Center immediately begins coordinating care. That physician works closely with a surgical team—if surgery is necessary—and other specialists, including neonatologists, who are the primary care team for newborns. From the moment of diagnosis until the birth of the baby, the family receives extensive counseling so they understand each step of the planned treatment process. In addition, specialists in maternal fetal medicine, neonatology, cardiology, and cardiac surgery meet monthly to review the upcoming patients who are expected to deliver babies with congenital heart defects. This allows for extensive discussion to ensure that all of the care givers are involved in the plan for each patient after birth.

Although most congenital heart defects detected by the fetal echocardiogram - can only be treated after the baby's birth, some fetal arrhythmias, or heart rhythm abnormalities, are treated during the pregnancy. An anti-arrhythmic medication can be used in a pregnant patient in order to manage fetal arrhythmias.

Scheduling a fetal echocardiogram

If you would like to schedule a fetal echocardiogram, you can self-refer or be referred by your obstetrician. For more information or to make an appointment for the test at the Phyllis and David Komansky Center for Children's Health, call (212)746-3561.

Contributing faculty for this article:
Sheila J. Carroll, M.D., F.A.A.P., F.A.C.C, Director of Fetal Cardiology at the Phyllis and David Komansky Center for Children's Health at NewYork-Presbyterian Hospital/Weill Cornell Medical Center, and Assistant Professor of Pediatrics in the Division of Pediatric Cardiology at Weill Cornell Medical College

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