Specialized fetal imaging to detect heart anomalies during pregnancy

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It could be the effect of climate change. Or perhaps it's due to fertility treatments, multiple births or a mother's own health condition.

There is no doubt, though, that congenital heart disease-; characterized by structural irregularities in the heart muscle-; is on the rise.

Although still rare-; occurring in roughly 8 in every 1,000 pregnancies-; congenital heart defects have steadily increased over the past three decades. To meet the growing need for pediatric and congenital heart experts who can identify-; and treat-; affected patients throughout their lives, the Smidt Heart Institute expanded its congenital and pediatric cardiac care to Huntington Health, an affiliate of Cedars-Sinai.

Susanna Tran, MD, along with colleague Robert Loitz, MD, is embedded in the San Gabriel Valley, practicing out of Huntington Health's Helen and Will Webster Heart & Vascular Center.

"Whenever possible, we strive to offer expert care that's closer to home," said Tran, who is fluent in English, Mandarin and Cantonese. "When it comes to fetal echocardiograms, we aim to make it as streamlined and convenient as possible for an expecting mother who already has a great deal on her plate."

As the nation continues to recognize American Heart Month, the Smidt Heart Institute's Ruchira Garg, MD, director of Congenital Noninvasive Cardiology in the Guerin Family Congenital Heart Program, and Tran sat down with the Cedars-Sinai Newsroom to spotlight specialized fetal imaging.

What is a fetal echocardiogram and who needs one?

Tran: A fetal echocardiogram is an ultrasound of the heart. There are certain conditions that we consider may present a higher risk for heart abnormalities in the developing fetus. These risk factors for an expecting mother include a family history of heart defects, structural heart defects, heart rhythm abnormalities, gestational diabetes, and if the mother is pregnant with more than one fetus. These are the situations in which we would perform a fetal echo to ensure that the fetus has a heart that is developing normally.

What abnormalities can be detected during a fetal echocardiogram?

Garg: Fetal heart anomalies range from structural anomalies to those of abnormal heart rhythm. It is quite common that we'll see a mother whose baby has some skipped beats, or extra beats, and fortunately, often these are benign. But then we have some mothers whose babies are noted to have an abnormally fast or abnormally slow heart rate, both of which can be dangerous to the fetus and result in fetal demise or need for early delivery.

The more common abnormalities we see are abnormalities of development. So, this really speaks to the field of pediatric cardiology. It's very different than adult cardiology. Pediatric cardiology tends to be primarily focused on disorders of development, and that can range from a hole that should not be in the heart or a valve that is leaky or narrowed. But it can even go to the severe spectrum of an entire side of the heart not forming correctly.

How do results from a fetal echocardiogram benefit families?

Tran: If we do detect a major structural heart problem, it can change the entire delivery plan-;and it requires a great deal of communication and coordinated care among the delivering OB-GYN, maternal-fetal medicine experts, nurses, cardiologists, cardiac surgeons and beyond. It really ensures that we can deliver-; and treat-; the newborn baby in the safest environment.

Garg: This knowledge provides an opportunity for parents to know that there's something abnormal, to prepare, to educate themselves, for us to educate them, and for our experts to create a specialized care plan. This knowledge also allows families to potentially mourn the loss of an otherwise completely healthy baby. Early fetal diagnoses are medically helpful, but emotionally and socially of great benefit to the families, too.

What makes Cedars-Sinai's pediatric and congenital heart programs unique?

Tran: The beauty of delivering at an academic medical center like Cedars-Sinai is that a mother can deliver in her own room, and then immediately-;if the baby needs neonatal intensive care-;those experts are right down the hall in the same building. Parents don't have to be separated from their baby like they would be at a stand-alone children's hospital, where mom has to stay in the hospital while the baby is transported to another hospital. Continuity is so important in these situations, and Cedars-Sinai can provide it.

Garg: We are a patient's medical home from conception, essentially until they are no longer here with us. We care for the fetus, babies, children and adults into senescence.

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