HJAR Jan/Feb 2021

HEALTHCARE JOURNAL OF ARKANSAS  I  JAN / FEB 2021 47 ease. Congenit Heart Dis 2017 Jan;12(1):67-73. 7. Lee W, Allan L, Carvalho JS, Chaoui R, Copel J, De- vore G, Hecher K, Nelson T, Paladini D, Yagel S; ISUOG Fetal Echocardiography Task Force. ISUOG consen- sus statement: What constitutes a fetal echocardio- gram? Ultrasound Obstet Gynecol. 2008; 32:239-242. 8. McBrien A, Hornberger LK. Early fetal echocardi- ography. Birth Defects Res 2019 May 1; 111(8): 370- 379. 9. Olson CK, Keppler-Noreuil KM, Romitti PA, Budelier WT, Ryan G, Sparks AR, Van Voorhis B. In vitro fertil- ization is associated with an increase in major birth defects. Fertil Steril. 2005; 84:1308-1315. 10. Ravi P, Mills L, Fruitman D, Savard W, Colen T, Khoo N, Serrano-Lomelin J, Hornberger LK. Popula- tion trends in prenatal detection of transposition of the great arteries:impact of obstetric screening ultra- sound guidelines. Ultrasound Obstet Gynecol 2018 May;51(5):659-664. 11. Rychik J, Ayres N, Cuneo B, Gotteiner N, Hornberg- er L, Spevak PJ, Ven Der Veld M. American Society of Echocardiography guidelines and standards for the performance of the fetal echocardiogram. J Am Soc Echocardiograph 2004;17:803-10. 12. Small M, Copel JA. Indications for fetal echocardi- ography. Pediatr Cardiol. 2004; 25:210-222. 13. Wen SW, Miao Q, Taljaard M, Lougheed J, Gaudet L, Davies M, Lanes A, Leader A, Corsi DJ, Sprague AE, Walker M. Associations of Assisted Reproduc- tive Technology and Twin Pregnancy With Risk of Congenital Heart Defects. JAMA Pediatr. 2020 May; 174(5): 1–9. Renee Bornemeier, MD is the interim chair of the department of pediatrics and professor of pediatric cardiology at the University of Arkansas for Medical Sciences (UAMS) and Arkansas Children’s Hospital (ACH) and is a native resident of Arkansas. Bornemeier is board certified in pediatric cardi- ology. She is the director of the Bale Fetal Heart Center at ACH. Her areas of focus and interest are fetal echocardiography, cardiac anatomy and pediatric echocardiography. Her professional memberships include the American College of Cardiology, the American Heart Association and the American Society of Echocardiography. with a congenital heart abnormality has now surpassed the number of children with the same. Despite the reality that cardiac malformations are serious problems, the future remains increasingly bright as medical knowledge advances their care. Identifying cardiac defects before birth is important not only to prepare the parents but also to appropriately plan for these tiniest of patients, affording them the best outcomes by anticipating the care they will need even before they arrive. n REFERENCES 1. Allan L. Technique of fetal echocardiography. Pedi- atr Cardiol. 2004;25:223-233. 2. American Institute of Ultrasound in Medicine. AIUM Practice Parameter for the Performance of Fetal Echocardiography. J Ultrasound Med. 2020; 39:E5- E16. 3. Carvalho JS, Allan LD, Chaoui R, Copel JA, DeVore GR, Hecher K, Lee W, Munoz H, Paladini D, Tutschek B, Yagel S. ISUOG practice guidelines (updated): so- nographic screening eamintion of the fetal heart. Ul- trasound Obstet Gynecol 2013;41: 348-359. 4. Donofrio MT, Moon-Grady, AJ, Hornberger, LK, Co- pel, JA, Sklansky, MS, Abuhamad A., et al. Diagnosis and Treatment of Fetal Cardiac Disease: A Scientific Statement from the American Heart Association. Cir- culation. Published online April 24, 2014. 5. Giorgione V, Parazzini F, Fesslova V, Cipriani S, Candiani M, Inversetti A, Sigismondi C, Tiberio F, Cavoretto P. Congenital Heart Defects in IVF/ICSI Pregnancy: Systematic Review and Meta-Anaysis. Ultrasound Obstet Gyneocol. 2018 Jan;51(1): 33-42. 6. Komisar J, Srivastava S, Geiger M, Doucette J, Ko H,Shenoy J, Shenoy R. Impact of changing indica- tions and increased utilization of fetal echocardiog- raphy on prenatal detection of congenital heart dis- Renee Bornemeier, MD Interim Chair of the Department of Pediatrics and Professor of Pediatric Cardiology University of Arkansas for Medical Sciences and Arkansas Children’s Hospital the parents is crucial, affording not only understanding but also providing family- centered care, allowing them to be more knowledgeable advocates for their child. From there, follow-up visits and repeat fetal echocardiograms are warranted to assess the fetus throughout the remainder of the pregnancy. A multidisciplinary team will then make plans for the baby’s arrival. Members of this teamoften include maternal-fetal medicine specialists, neonatologists, fetal cardiologists, cardiac intensivists and congenital cardiovascular surgeons. The plans include delivery location, medications, the potential need for transfer to a tertiary care hospital and surgery or other interventional procedures that are likely to be needed. Looking back over the past 50 years, dramatic improvements in surgical techniques and outcomes for patients with congenital heart defects have also been achieved. This affords opportunity for previously inoperable defects to now have viable surgical options with remarkable outcomes. With ever-improving care, these children now survive to adulthood. Today in this country, the number of adults HIGH RISK CATEGORIES THAT WARRANT A FETAL ECHOCARDIOGRAM MATERNAL OR FAMILIAL • Pregestational diabetes • Gestational diabetes early in preg- nancy • In-vitro fertilization • Maternal phenylketonuria • Auto-immune disease—as seen in lupus and Sjogren’s syndrome • Teratogenic medication exposure • First trimester rubella infection • First-degree relative of a fetus with CHD (parents, siblings or prior preg- nancy) • First- or second-degree relative with disease of Mendelian inheritance and a history of childhood cardiac manifestations FETAL • Suspected cardiac structural anomaly • Suspected abnormality in cardiac function • Hydrops fetalis • Persistent fetal tachycardia (heart rate > 180 bpm) • Persistent fetal bradycardia (heart rate < 120 bpm) or a suspected heart block • Frequent episodes or a persistently irregular cardiac rhythm • Major fetal extracardiac anomaly • Nuchal translucency of 3.5 mm or greater or at or above the 99th per-centile for gestational age • Chromosomal abnormality • Monochorionic twinning Scan this QRCode to see a clip of a Fetal Echocardiogram