Performance of Early Fetal Echocardiography: An Expert Statement from the Fetal Heart Society

Miwa K. Geiger, Division of Pediatric Cardiology, Department of Pediatrics, Kravis Children's Hospital, Icahn School of Medicine at Mount Sinai, Gustave L. Levy Pace, Box 1201, New York, NY 10029 USA. Electronic address: miwa.geiger@mssm.edu.
Angela McBrien, Fetal & Neonatal Cardiology, Division of Cardiology, Department of Pediatrics, University of Alberta and the Stollery Children's Hospital Cardiac Program, Edmonton, Alberta, Canada.
Lisa K. Hornberger, Fetal & Neonatal Cardiology, Division of Cardiology, Department of Pediatrics, University of Alberta and the Stollery Children's Hospital Cardiac Program, Edmonton, Alberta, Canada.
Anita J. Moon-Grady, Division of Pediatric Cardiology, UCSF Benioff Children's Hospital, Department of Pediatrics, University of California San Francisco, San Francisco, CA 94158 USA.
Nitin Madan, Division of Pediatric Cardiology, Children's Mercy Kansas City, UMKC School of Medicine, Kansas City, MO 66211 USA.
Julene S. Carvalho, Brompton Centre for Fetal Cardiology, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust and Cardiovascular and Genomics Research Institute, City St. George's, University of London, London, United Kingdom.
Liat Gindes, Ultrasound Unit, Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon Israel and Faculty of Medical and Health Sciences, Tel-Aviv University, Tel-Aviv, Israel.
Leila Rittey, Cardiology, Great Ormond Street Hospital for Children, London, United Kingdom.
Joyce T. Johnson, Heart Institute, Johns Hopkins All Children's Hospital, St. Petersburg, FL 33701 USA.
Mary T. Donofrio, Division of Cardiology, Children's National Hospital, George Washington University School of Medicine, Washington DC 20010 USA.
Sheetal Patel, Division of Pediatric Cardiology, Ann & Robert H Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL 60611 USA.

Document Type

Journal Article

Publication Date

10-11-2025

Journal

Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography

DOI

10.1016/j.echo.2025.09.020

Keywords

Congenital heart disease; Early fetal echocardiography; Fetal echocardiography; First trimester

Abstract

Congenital heart defects (CHD) are the most common lethal congenital anomalies. Fetal echocardiography is the mainstay for the diagnosis and subsequent serial assessment of fetal cardiovascular disease. Ideal timing for fetal echocardiography has traditionally been cited as between 18-22 weeks gestation, though many centers now offer evaluations at 16 weeks gestation and onward. Improved ultrasound resolution and a better understanding of early fetal cardiac development have enabled experienced specialists to diagnose major CHD as early as 11-15 weeks gestation. An earlier diagnosis of CHD allows families to make time-sensitive decisions regarding the continuation of pregnancy while also providing time for additional prenatal testing and thoughtful perinatal planning. Reassuring early fetal echocardiography (eFE) can reduce anxiety in families with elevated risk for fetal CHD, such as those with a prior fetus or child with CHD. Given the benefits of early detection, the American Society of Echocardiography's 2023 Guidelines and Recommendations for Performance of the Fetal Echocardiogram included a section on eFE, which reviewed suggested elements, benefits, and limitations. However, there are challenges regarding the technical aspects of imaging a smaller heart as well as prognosticating during the late first and early second trimester. Most pediatric cardiologists have not had specific training in these skills and, therefore, often do not offer fetal echocardiography before 16 weeks gestation. To overcome these challenges, the Program Leaders' Committee of the Fetal Heart Society developed this document, in which we review potential indications, propose an imaging protocol for early transabdominal and adjunct transvaginal (or endo-vaginal) fetal echocardiography, discuss unique findings in early gestation fetal heart morphology and hemodynamics, consider limitations, and discuss important aspects of patient counseling for eFE. Figures and videos of both normal and abnormal eFE are included in the Appendix/Supplementary Media.

Department

Pediatrics

Link to Full Text

Share

COinS