HJAR Jan/Feb 2021

46 JAN / FEB 2021 I  HEALTHCARE JOURNAL OF ARKANSAS CHILDREN’S HEALTH COLUMN CHILDREN’S HEALTH FETAL ECHOCARDIOGRAPHY: Assessing the Heart Before Birth groups have also been identified with an increased incidence of fetal cardiac malformations. It is warranted for these high-risk groups to be referred for fetal echocardiography, as well. (See Table) Duringafetalechocardiogram,adetailed look at the cardiac anatomy, heart rate, rhythm and function is performed. Two- dimensional imaging, M-mode analysis, color flow and Doppler assessments are obtained to assess structure and function of the heart, along with directionality and velocity of blood flow. Once the diagnosis of a congenital heart malformation is made, an in-depth discussion with the parents is necessary. The provider should discuss what is visualized in normal cardiac anatomy and then provide a detailed explanation of how the child’sheart differs and if surgerywill be needed. Additional information regarding surgical goals and outcomes, common problems encountered, and quality of life should all be presented. Educating THESE are words that would paralyze any soon-to-be-parent. As parents, they are words one never expects to hear, and as physicians, they are words we never want to speak. Yet, congenital heart defects are the most common of all birth defects, occurring at a rate of approximately 8 cases per 1000 live births. Over the last 50 years, prenatal assessments have contributed an unprecedented amount of knowledge about the unborn child. As part of this diagnostic capability, an ultrasonographic evaluation now serves as a standard of care and a window to view the fetal environment, allowing for the diagnosis of most congenital anomalies before the birth of the baby. Timely access to prenatal care and a thorough patient history to identify risk factors, along with the routine prenatal scan, are all critical to determine which pregnancies need a more specialized examination. One important aspect of the fetal exam is the evaluation of the fetal heart. The routine obstetric scan should evaluate the basic cardiac structure, including the four chambered view as well as the two outflow tracts. Symmetry between the right and left sided structures should be observed, and the course of the great arteries should cross. If the images demonstrate asymmetry between the cardiac chambers or great arteries, a rhythm disturbance, an abnormal communication or other cardiac concern, a referral for a more specialized cardiac assessment, known as a fetal echocardiogram, is warranted. High-risk Having a child should be one of the most joyful times in a couple’s life. However, that can all change when you hear, “Your baby may have a heart defect.”