Congenital heart diseases (CHD) are anomalies seen in 1% of all births and are the most commonly detected anomalies in infants. It is possible to diagnose, and sometimes even treat, these diseases in the womb. The evaluation of the baby’s heart using ultrasonographic waves and special systems is called “Fetal Echocardiography”. After diagnosis, information can be provided about the course of the disease, possible procedures, and treatment.

Fetal echocardiography, Who should undergo it?

Since congenital heart anomalies are the most common anomalies and this test has no harm to the mother or baby, it is performed as a screening test in most European countries for every pregnancy. Thus, almost all CHDs are diagnosed. Apart from this, it should definitely be performed in the following special situations.

  • In the mother

Presence of infectious diseases during pregnancy,

Chronic diseases in the mother (Diabetes, Rheumatism, etc.),

Medication use during pregnancy, exposure to radiation (X-ray, CT scan, etc.)

Hypertension or high-risk pregnancies

If there are abnormalities in screening and biochemical tests

History of stillbirth or miscarriage

Advanced maternal age pregnancies

  • In the baby

If there is a chromosomal anomaly or suspicion

Suspicion of cardiac or non-cardiac anomaly on ultrasound

Suspicion of arrhythmia

If nuchal translucency is high

If there is growth restriction in the baby

If there is irregular heart rhythm

  • In the family

If there is a history of congenital heart disease in the family

If there are genetic abnormalities in parents or siblings

  • If recommended by the obstetrician

 

Does fetal echocardiography harm the baby and how long does the procedure take?

The procedure is no different from ultrasound and is performed using sound waves. It has no side effects or harm to the baby. The procedure takes approximately 20 minutes. It may take longer in the presence of a serious anomaly. During this time, the mother lies on her back just like in ultrasound, and the procedure is performed through the abdomen.

When should fetal echocardiography be performed?

The ideal timing for this procedure is between 19–24 weeks of pregnancy. In case of suspicion of serious heart anomalies, it can be performed from the 16th week. After the 24th week, the procedure becomes more difficult due to the development of the baby’s bones. Also, after the 24th week, even if a severe heart disease is diagnosed, there may be nothing that can be done for the baby. Therefore, the test should not be delayed beyond the 24th week.

Can all heart diseases be detected with fetal echocardiography, is there a margin of error?

When performed by an experienced pediatric cardiologist, the accuracy rate is over 90%. Especially the detection rate of serious heart diseases is 100%. However, very small defects and some openings that are normal in the womb may only be detected after birth. These small problems that cannot be detected do not harm the baby after birth. The most important point here is that openings that are normal in the womb may cause heart disease if they persist after birth. This slightly increases the margin of error. Therefore, if necessary, babies who undergo fetal echocardiography should have a standard echocardiography after birth as recommended by a pediatrician. The physician performing the procedure will already provide information about this.

What are the benefits of Fetal Echocardiography?

Knowing congenital heart disease in advance provides numerous benefits for both the mother and the baby. Problems such as arrhythmias, which may lead to the death of the baby in the womb, can be treated during pregnancy. Encountering a baby with a heart problem unexpectedly after birth has many disadvantages for both the mother and the baby. There are heart diseases where hours are critical in treatment, and delivery should take place in a center where angiography and surgery are available. When pediatric cardiologists are aware of these conditions, they prepare all precautions and medications accordingly. This rapid process significantly increases the baby’s chance of survival. Because today, most of these diseases are treatable. Another very important point is that there are some congenital heart diseases for which treatment is not possible, or even if treated, the child may never have a normal heart and their quality of life may be very poor. This is the most important benefit of this procedure. In such cases, continuing the pregnancy may not be meaningful, and the pregnancy can be terminated. Fetal ECHO provides this option to the family and the mother.

 

Prof. Dr. Ertürk Levent

Pediatric Cardiologist

Ege University Faculty of Medicine, Department of Pediatric Cardiology, IZMIR

erturk.levent@ege.edu.tr  

 

Figure 1. Imaging of a life-incompatible heart disease with Fetal ECHO