Heart of theValley Heart of theValley

Fetal Cardiology Fetal Cardiology

Information for Patient and Provider
2-D view of fetal heart at the level Fetal Cardiology
of the aortic and tricuspid valves
Main Clinic: Pleasanton Clinic
Education and
5933 Coronado Lane, Suite 1 F
counseling for
Pleasanton, CA 94588
families

Our Fetal Cardiac Management Services: Satellite Clinics: Cardiac care

Fremont, Tracy, Brentwood, San Mateo pre- and post-
* Assessment of cardiac structure, function and rhythm natally
* Education and counseling for families
* Medical care both pre- and postnatally
* Referral resource for genetic testing, perinatology
services, post-partum cardiac care and cardiac surgery.
* Heart of the Valley is in the unique position of
independence from any single medical institution. This
allows a choice of the best possible specialized center
for further care of mother’s and baby’s unique needs. Please visit our website for locations of satellite clinics Assessment of congenital
at www.heartofthevalley.us heart disease, fetal
arrhythmias and fetal
cardiac function

Doppler interrogation of mitral valve inflow showing normal ColorDoppler echocardiogram of aortic
blood flow velocity, rhythm, AV syncrony and heart rate. and ductal arches

Andrew J. Maxwell, MD, FACC Heart of the Valley Pediatric Cardiology

Dr. Maxwell is a Board Certified Pediatric is a full-service pediatric cardiology clinic
Cardiologist and Pediatrician. He received his APPTS. AND REFERRALS: serving expecting parents, infants, children and
medical degree from Johns Hopkins Medical young adults.
School, completed a Residency in Pediatrics Contact us at 925-416-0100
at UCSF and Fellowships in Pediatric Cardiol-
ogy at Packard Children’s Hospital at Stanford MORE INFORMATION:
and Children’s Hospital of Philadelphia. He has
been in private practice since 2002. visit www.heartofthevalley.us
 HEART OF THE VALLEY - Fetal Echocardiology
What is fetal echocardiography?
Fetal echocardiography is a test using ultrasound (sound
waves) to study the structure, function and rhythm of your
baby’s heart before birth. Your obstetrician may obtain a
general view of your baby’s heart during a routine pregnan-
cy ultrasound. However, a fetal echocardiogram is a very
detailed evaluation of your baby’s heart by a specialist in
fetal cardiology.
How is the test performed?
The test is done by the specialist in a manner similar to a
routine fetal sonogram. It is painless and takes about 30
minutes. There are no known risks to the mother or the
fetus however recent studies of possible subtle effects on
fetal brain development suggest that its use should not be
frivolous. After the test, parents are fully informed of the
results and questions are answered.
What conditions can be identified?
Structural abnormalities known as congenital heart disease
(CHD), cardiac rhythm disturbances (or arrhythmias), and
disorders of cardiac function can be identified.
Who needs a detailed fetal echocardiogram?
Reasons (indications) for considering this test include:
A. FETAL REASONS:
1. The recognition of other birth defects, chromosomal or
genetic abnormalities, or an abnormal amniocentesis.
2. Presence of polyhydramnios: excessive amniotic fluid.
3. Presence of fetal hydrops: the abnormal accumulation of
fluid in two or more body cavities (abdomen, lungs, heart).
4. Fetal arrhythmias: brady-
cardia (slow heart rate) is as-
sociated with structural anom-
alies of the heart. Tachycardia
(fast heart rate) may result in
poor heart function. Skipped
beats are typically innocent.
All can be identified by fetal
echocardiography.
B. MATERNAL REASONS:
1. Diabetes mellitus has a cardiac defect rate as high as 5%. This
excludes late gestational diabetes which does not have an addi-
tional risk of heart disease.
2. Maternal auto antibodies (lupus type) are associated with fe-
tal bradycardia and varying degrees of heart block. In the setting
of a previously affected fetus, the recurrence risk is 20%.
3. Maternal medication exposure: Vitamin A analogues Isoreti-
noin (topical preparations are not a risk), anti-seizure medica-
tions, alcohol, tobacco and lithium are all potential cardiac
teratogens. A teratogen is anything that causes abnormal devel-
opment of fetal structures.
4. Maternal congenital heart disease: Mothers who have signifi-
cant CHD have a 5% incidence of having a child with a CHD.
5. In vitro fertilization is for an unknown reason associated with
an increased risk for CHD.
C. FAMILY HISTORY REASONS:
1. Families with a sibling or the father with CHD have a 2% risk
of recurrence with subsequent pregnancies, although there may
be some variation with certain lesions.
2. If a sibling has a genetic syndrome associated with CHD then
the recurrence risk depends on the risk of the recurrance of the
syndrome.
When can the test be performed?
This test can be performed at 17 weeks gestation or after. Some-
times repeat examinations are needed.
Are there limitations of this test?
Some heart abnormalities are not detectable prenatally even with
a detailed expert examination. These tend to be minor defects,
such as small holes in the heart, or mild valve abnormalities. In
addition, some serious cardiac defects do not become evident
until after birth. Becaue the fetal echocardiogram focuses on the
heart. The fetal echocardiographer does not usually see defects
in other parts of the fetus.
What are the implications of this test?
* The detection of a heart defect increases the risk of finding
other malformations in the child. A detailed ultrasound of the
rest of the fetus is some-
times necessary and an
amniocentesis to test the
chromosomes may be rec-
ommended.
* A serious or even life-
threatening heart abnor-
mality may be identified.
It may have a significant
impact on the future of the baby. You will want to discuss this
with your doctors.
* Cardiac rhythm disturbances often need to be treated before
birth. Defects of cardiac structure are usually treated after the
birth.
* In most cases of CHD diagnosed prenatally, delivery may
proceed as planned in the birthing center of the parent’s
choice. In some cases, especially true if surgery will be re-
quired soon after birth, it is safest to deliver the pregnancy
at, or near, the center at which postnatal treatment will take
place.
Who can counsel or advise me afterwards?
* A obstetrician or perinatalogist can advise you about the
management of your pregnancy.
* A pediatric cardiologist is in the best position to give advice
about the outlook for your child’s heart problem.
* A geneticist can provide information about a fetus with an
associated genetic syndrome, if present, and advise about fu-
ture pregnancies.
* A cardiac surgeon can give details about any surgical proce-
dures that may be needed.
What is the impact of this test?
Fetal echocardiography has had a tremendous impact with
improved diagnosis and appropriate counseling for families.
It aids in the management prenatally and guides the timing,
location, and route of delivery. The prenatal accurate diag-
nosis will improve the outcome of some fetuses with severe
cardiac malformations. Fetal echocardiography is beginning
to identify candidates for fetal cardiac intervention and guide
these procedures.