Incidence of Congenital Heart Disease in the Fetus

consensus has formed among sonographers, radiologists, obstetricians, and maternal-fetal medicine subspecialists: screening for fetal heart disease deserves the dubious distinction of being one of the most challenging and least successful aspects of fetal ultrasonography. Because of the challenges inherent with screening the fetus for congenital heart disease (CHD), the rate of prenatal detection of even severe forms of CHD remains disappointingly low. Furthermore, when a fetal heart defect or arrhythmia is suspected, many professionals feel uncomfortable with much more than referring the patient to someone else for further evaluation. This chapter aims neither to make everyone involved with fetal ultrasonography into an expert fetal echocardiographer, nor to provide an exhaustive, encyclopedic review of the fi eld of fetal cardiology; such detailed reviews may be found elsewhere. Instead, the chapter takes a distinctive clinical bent, aiming to help those involved with fetal cardiac imaging (1) to become better at screening the fetal heart for CHD, (2) to become better at diagnosing and evaluating common forms of fetal cardiac malformations and arrhythmias, (3) to understand the basic approach to fetal and neonatal management of the most common forms of fetal cardiac malformations and arrhythmias, and (4) to understand the general prognosis associated with the most common forms of fetal heart disease. After a brief discussion of the epidemiology of fetal heart disease, this chapter reviews the basic approach to screening in low-risk pregnancies for fetal heart disease. The next section reviews the more detailed technique of formal fetal echocardiography in pregnancies at high risk for fetal CHD, including a description of the fetal presentation of fetal congestive heart failure (CHF) and a discussion of the potential role of three-dimensional (3D) fetal echocardiography. The last two sections discuss the diagnosis, management, and prognosis of the most common and clinically important forms of fetal cardiac malformations and arrhythmias.