Fetal Cardiology

Twenty years ago, young patients might have reached their teens before being diagnosed with congenital heart disease. Now, cardiologists can detect pediatric heart conditions as early as the mother’s fourth month of pregnancy. Consequently, long-term outcomes are improving, as early detection offers more accuracy and advanced planning for postnatal treatment. 

Thanks to 10 years of experience, a multidisciplinary approach and state-of-the-art technology, the team at the Fetal Heart Center at The Children’s Hospital at Montefiore (CHAM) can identify pediatric heart conditions within a life-saving time frame. “Before fetal cardiology was developed, most babies with serious heart defects did not survive past the first two to three days of life,” notes Rajesh Shenoy, MD, FAAP, FACC, Attending Physician, Division of Pediatric Cardiology. “Most of them now have a clinical diagnosis even before birth and we can alert obstetrics and the neonatal intensive care unit early enough to begin treating them immediately after birth.”

About the fetal echocardiogram

A fetal echocardiogram uses sound waves to assess the structure and function of a baby’s heart. It is noninvasive, safe and painless, and takes approximately 45 to 60 minutes. After evaluating the imaging study, one of our fetal cardiologists shares a thorough explanation and results with the mother and family members. Some cardiac conditions may be treated prior to the birth of the baby, while others may require treatment immediately after the baby is born. The advanced awareness of any heart condition is highly beneficial to mothers and family members, who have time to accept the diagnosis and plan ahead for their child’s treatment. 

Advanced fetal echocardiography technology

CHAM echocardiography attendings use advanced technology, such as 2D and 3D echocardiograms, Doppler imaging, speckle tracking echocardiography and fetal biometry (tracking fetal growth) to gather critical information. The detailed noninvasive imaging studies provide enhanced imaging quality and a vast amount of quantitative data.

“In the past, nobody thought we’d have use for this data,” explains Leo Lopez, MD, Director of Noninvasive Imagining, Pediatric Cardiology, CHAM. “But the assessment of ventricular volumes and mass, myocardial velocity and other critical measures enables specialists to prognosticate and customize treatment for each child with congenital heart disease.”

It also minimizes the number of diagnostic tests and invasive procedures. “We don’t want children to incur any of the unnecessary risks of catheterization, general anesthesia or the radiation from a CT scan,” remarks Dr. Lopez.

Collaboration with referring physicians

Dr. Lopez and his team screen more than 20 patients each week from across the New York tri-state region. Many of these are same-day referrals for patients with arrhythmia or other potentially dangerous conditions. They partner closely with Pe’er Dar, MD, and the High-Risk Obstetric Ultrasound Service at Montefiore Medical Center to ensure that all fetuses with potential heart defects are thoroughly evaluated.

“Referring physicians are our partners in the identification of fetal heart disease,” Dr. Shenoy explains. “If a referring physician suspects heart disease, we are able to perform a fetal echocardiographic examination that same day.”

Besides prompt appointments, another primary reason cited for referring patients to CHAM is its coordinated care. “Cardiologists, interventional cardiologists, cardiothoracic surgeons and our dedicated nurses work seamlessly together to help each patient. For conditions such as hypoplastic left heart syndrome (HLHS), we use the hybrid approach, which involves coordinated interventions by surgeons and cardiologists in the hybrid operating room,” Dr. Shenoy notes. “Our team has, by far, the most experience with hybrid surgery in the New York metropolitan area.”

This holistic approach is transforming the fetal cardiology discipline, and most importantly, lives. “It’s always devastating for parents to learn of their child’s diagnosis of a heart condition,” Dr. Shenoy empathizes. “But knowing this far ahead of the actual birth helps families prepare and allows physicians to coordinate care. We have quite a few babies who have had three operations, which is the typical course, and when you see them as four- and five-year-old schoolchildren who you’ve followed since fetal life, it’s a wonderful feeling.”