Fetal Cardiology

Whether your doctor has referred you to one of the expert fetal cardiologists of our Fetal Cardiology Program or whether you are seeking answers on your own, our whole team is here to:

  • Support you
  • Provide you and your unborn child with state-of-the-art care
  • Answer your questions

Our dedicated team of doctors and nurses work closely as a collaborative team with one overriding goal to provide you and your unborn baby the best, most compassionate and supportive care possible.

Expecting a baby is one of life’s most thrilling times. It also can be a time of great stress when couples learn that there might be a problem with their unborn baby.

When that happens, prospective parents need the best medical and emotional care they can find.

When the unborn baby has a problem with the heart, families need the services of doctors who specialize in caring for both unborn babies and newborns and children with heart problems.

The Fetal Cardiology Program provides all of this and more, with a seamless collaboration with the Heart Institute and the Institute for Maternal-Fetal Health.

Comprehensive Care

Our program works closely with individual obstetricians, radiologists, and perinatologists in our community to coordinate care of affected pregnancies.

In close collaboration with the hospital's Heart Institute and the Institute of Maternal-Fetal Health, we offer a comprehensive team approach to management, with:

  • State-of-the-art perinatology
  • Highly specialized expertise in fetal interventions
  • Comprehensive fetal and neonatal subspecialty care
  • Seamless transition from fetal life to medical and surgical care of the newborn infant following delivery
  • World-class congenital heart surgery, under the leadership of Vaughn Starnes, MD at the Heart Institute.
  • Fetal Cardiology FAQs
  • Our Goals
  • Physician Specialists
  • Fetal Maternal Center
  • Emotional Care and Managing Appointments

What Is a Fetal Echocardiogram ('Fetal Echo')?

A fetal echocardiogram, or fetal echo, is an ultrasound test with a specific focus on the structure and function of the fetal heart. It uses the same ultrasound technology as other prenatal scanning examinations performed by obstetricians, perinatologists, and radiologists. This test is usually performed by a sonographer or subspecialty physician, such as pediatric cardiologist, perinatologist, or radiologist.

Here, at our Fetal Cardiology Program, every fetal echocardiogram is performed by a pediatric cardiologist with special expertise in fetal cardiology. The fetal echo is usually performed between 18-22 weeks gestation (sometimes as early as 13 weeks or as late as the end of the third trimester), and usually takes between 20-60 minutes to complete.

Ultrasound modalities performed include two-dimensional imaging, 3-dimensional imaging and color flow and pulses, and Doppler evaluation of blood flow. After the study is performed, the patient is always counseled by a pediatric cardiologist on the diagnosis, prognosis, recommendations and plan of care.

What Is Pediatric Cardiology?

The field of pediatric cardiology traditionally has encompassed the diagnosis and treatment of both inherited and acquired heart disease in children from birth to adulthood (0-21 years old).

However, in the modern era with the current advances in imaging technology, the care of our patients begins in the womb. It is now the job of the fetal cardiologist to make a diagnosis of heart disease early during the pregnancy, counsel families on the nature and prognosis of detected abnormalities, and establish appropriate management plans for affected pregnancies prior to delivery.

The ultimate goal is to optimize information available to families, and to optimize the outcomes of children born with congenital heart disease. In some cases, therapy can be offered to alter the prenatal natural history of congenital heart disease.

Following the prenatal diagnosis of congenital heart disease, the family can learn about the diagnosis and management, make decisions regarding delivery site, tour the chosen facility’s cardiothoracic intensive care unit (CTICU), and meet their child’s future surgeon.

After the infant is born the pediatric cardiologist will confirm the diagnosis, help with clinical management, and work closely with the surgeons and pediatric intensivists to decide upon the most appropriate surgical intervention.

Pediatric cardiologists will also continue to follow and care for children born with congenital heart disease throughout childhood.

What Is Congenital Heart Disease (CHD)?

Approximately one out of every 100 live born infants (~1 percent) will be born with a congenital heart defect, which usually develops during the embryologic formation of the heart (first trimester).

These defects can be straightforward, such as a hole in the heart connecting two chambers (atrial or ventricular septal defect) or an abnormal heart valve (pulmonary or aortic stenosis) both of which may require little or no treatment depending on the severity.

They can also be more complex defects in which a major portion of the heart does not form (such as hypoplastic left heart syndrome) or the anatomic connections are abnormal (such as transposition of the great arteries).

Perhaps three out of every 100 live born infants will be born with a heart defect that requires emergent stabilization of the baby shortly after birth, followed by surgery or cardiac catheterization within the first days to weeks of life.

What Causes Congenital Heart Disease (CHD)?

Both genetic and environmental factors are suspected in the formation of congenital heart disease, but there is still much that is unknown. Specific gene defects (22q11 deletion, trisomy 21) have been identified which have a very strong association between congenital heart disease and more generalized syndromes. In addition, there are environmental factors such as maternal diabetes, and specific medications (such as anticonvulsants or warfarin) that have been associated with increased rates of heart defects. However, most infants born with heart defects have no known cause and are otherwise healthy.

Who Should Have a Fetal Echocardiogram?

Pregnancies may be at risk for congenital heart disease for a variety of fetal, maternal or familial reasons.

Fetal risk factors include:

  • An abnormal appearing heart
  • Abnormal heart rate or arrhythmia on routine screening ultrasound
  • Aneuploidy (chromosomal abnormality)
  • Increased nuchal translucency thickness at first trimester evaluation
  • Noncardiac fetal structural abnormalities
  • A two-vessel umbilical cord
  • Twins
  • Fluid accumulation in the fetus

Maternal risk factors include:

  • Maternal diabetes, lupus or other systemic disease that involves the heart (such as DiGeorge Syndrome)
  • First-trimester use of known teratogens
  • IVF pregnancies
  • Maternal congenital heart disease

Familial risk factors include:

  • A history of a previous child being born with a heart defect
  • The father being born with a heart defect
  • Other close relatives being born with heart defects or syndromes known to involve the heart

Fetal Cardiology Resources

Support Groups

Adult Congenital Heart Association

International organization that provides information and support for older patients with congenital heart disease.

California Heart Connection

Offers support, information and resources for those patients and families with congenital heart disease. Also provides ways to connect such families/patients through special events and online support groups. Based in Orange County, California.

Little Hearts, Inc.

Offers online support for families with congenital heart disease.

The Congenital Heart Information Network

Offers online support for families with congenital heart disease.

Our goals are to provide:

  • State-of-the-art prenatal and perinatal clinical care with the best possible outcomes for the fetal patient with congenital heart disease
  • Educational resources for parents and families of children with congenital heart disease
  • Educational resources for professionals interested in improving the prenatal detection of congenital heart disease
  • Formal training in fetal cardiology to primary and four-year pediatric cardiology fellows, and to provide training in fetal cardiac imaging to radiology and obstetric residents, maternal-fetal medicine fellows, practicing obstetricians/perinatologists, and obstetric/cardiac sonographers

In addition, our final goal is to conduct clinical and translational research that improves the prenatal detection, diagnosis treatment and outcome of the fetus with congenital heart disease.

Physician Specialists

Pediatric cardiologists are doctors with special training in diagnosing, managing and caring for babies with all types of heart conditions. Our Fetal Cardiology Program brings the expertise of fetal cardiologists (pediatric cardiologists with special training and expertise in diagnosing and treating heart disease in the unborn child) into a close collaboration between the Institute for Maternal-Fetal Health (large team of medical professionals dedicated to caring for unborn babies with all types of problems) and the Heart Institute (dedicated team of pediatric cardiothoracic surgeons, cardiologists and nurse practitioners).

Fetal Cardiologists

Fetal cardiologists are pediatric cardiologists with extra training in diagnosing and caring for unborn babies, as well. Some babies will need surgery to correct their heart problems.

Pediatric Cardiothoracic Surgeons

Pediatric cardiothoracic surgeons are the doctors who specialize in heart surgery to repair or correct heart conditions that need surgery. The Heart Center has cardiothoracic surgeons that can perform every type of neonatal heart surgery known, including cardiac transplantation.

Collaborative Team Approach

When an unborn baby has any type of problem, including a problem with the heart, the best care involves a team of specialists dedicated to providing everything possible, in the hope of reaching the best possible outcome.

Parents and their unborn baby may need many types of care and services from a variety of different nurse and physician specialists. They may need the services of a maternal-fetal specialist, otherwise known as a perinatologist, a doctor who cares for unborn babies with any type of problem. They may need to speak with a genetic counselor, or a doctor who specializes in genetics. Or they may need to see one or more pediatric sub-specialists, doctors who care for different types of problems and conditions.

When a heart abnormality is detected prenatally, the Fetal Cardiology Program turns to the faculty and staff at the Fetal Maternal Center to provide all these services for you in one place. The center can help take care of your unborn baby from the time a problem is found through delivery, and can help guarantee that specialized care is begun at the very earliest moment possible. If special plans for delivery are needed, the Fetal Maternal Center provides general obstetric and maternal-fetal medicine services, as well as a full-service delivery hospital and neonatal intensive care unit (run by neonatologists from our hospital).

One of the most difficult aspects of learning that their unborn baby may have a problem is having to struggle with making appointments with all the doctors they may need to see. The couple may not know what kind of doctors to see for the problem their unborn baby has, or who the most experienced doctors are. Another difficulty is getting the answers and information you need to make choices for yourself, your family, and your new baby. We can help with all of these difficult things. Our care is aimed at finding the best plan for each unborn baby, helping make sure that each step of the care is done the right way, while helping the parents through this confusing time.