New dimensions and directions in fetal cardiology.

Abstract

The purpose of this review is to describe several of the most relevant and exciting recent advances in the field of fetal cardiology. First, the prenatal detection of congenital heart disease has improved, and continues to improve, with the increasingly widespread incorporation of the four-chamber view and outflow tracts into the routine screening fetal ultrasound evaluation. Second, increasingly sophisticated computer processing systems and improvements in imaging technology have enabled the development of automated three-dimensional ultrasound imaging systems that promise to revolutionize both the prenatal detection and diagnosis of congenital heart disease. Conventional two-dimensional imaging approaches may soon become obsolete. Third, there has been an increasing ability to intervene successfully prenatally not only for fetal arrhythmias and heart failure, but also for some forms of structural heart disease. In some cases of left or right ventricular outflow tract obstruction, early intervention during the second trimester may prevent the development of ventricular hypoplasia. Finally, several recent studies suggest that prenatal diagnosis may improve neonatal outcome for fetuses with congenital heart disease. The growing ability to intervene prenatally has the potential to improve neonatal outcome still further. These critical and exciting developments in fetal cardiology promise to increase fetal echocardiography's clinical impact dramatically during the years to come.