Your Visit | Overview
Evaluation and diagnosis
At your first appointment, your cardiologist will use advanced diagnostic tests to determine the health of your baby's heart. A congenital heart defect (CHD) is a heart problem that occurs while the heart is still developing and is present at birth. Defects can range from holes between heart chambers to more severe defects, such as a blocked heart valve or heart chambers that are underdeveloped.
Heart defects can sometimes be detected using a specialized cardiac ultrasound called echocardiography. Other tests we may perform include:
How early in my pregnancy can a heart defect be detected?
Heart defects are typically detected when a fetus is 16 to 22 weeks old, since this is the usual age at which most pregnant women undergo a screening obstetric ultrasound. Some serious heart defects can be detected as early as 14 weeks.
How are congenital heart defects diagnosed?
Fetal ultrasounds are performed in most pregnant women to monitor fetal growth and to detect abnormalities. Serious congenital heart defects can be found during routine fetal ultrasounds. If your baby has potential risk factors, like a family history of heart disease, our cardiologists can carefully examine your baby's heart.
When are diagnostic tests necessary?
Most women will have a second trimester ultrasound by an obstetrician or radiologist that evaluates the heart in addition to the rest of the fetus. This is sufficient in most cases. It is not necessary for all pregnancies to undergo fetal echocardiography unless the ultrasound detects a heart abnormality. A fetal echocardiogram may be necessary if:
- heart abnormalities are discovered in a routine prenatal ultrasound
- there is a family history of congenital heart disease
- the fetus has a chromosomal or genetic abnormality
- a mother has taken certain medications that may cause congenital heart defects
- the mother has abused alcohol or drugs during pregnancy
- a mother has diabetes or a connective-tissue disease, such as lupus
- the mother had rubella during pregnancy
If your baby is diagnosed with a heart defect, our staff will sit down with you to discuss your baby’s condition, treatment options and long-term outlook.
When heart defects are detected while your baby is still in the womb, we are able to better manage your baby’s care before and after delivery, and minimize the risks for future problems, such as learning disabilities and organ damage.
Depending on your baby’s condition, we may be able to repair her heart defect before she is born. Not all babies can be operated on before birth, however.
Caring for the heart and beyond
About 40 percent of babies with a cardiovascular defect also have non-cardiac problems. At Boston Children’s, if your baby has been diagnosed with a heart defect, we will connect you with other specialists within Boston Children's to ensure that your baby receives the best possible care for all medical needs.
Boston Children's has established itself as one of the preeminent hospitals in the world for fetal heart surgeries, which are procedures to correct a baby's heart defect while still in their mother's womb.
When is fetal therapy the best option?
Recent advances in methods of prenatal diagnosis and ultrasound-guided surgical and catheterization techniques have made fetal therapy possible. Most cardiovascular defects are best treated after a baby is born. However, for a select group of heart defects, in utero therapy may be an option.
Fetal therapy is performed to improve or correct problems that would be too advanced to correct after birth.
Types of defects that may require fetal therapy
The Fetal Cardiology Program at Boston Children's treats both fetal heart rhythm problems and structural heart defects. Fetal heart rhythm problems (arrhythmias) respond well to therapy while still in utero. Our fetal cardiologists work together to monitor and treat potentially life threatening fetal arrhythmias, such as supraventricular tachycardia, the most common serious fetal arrhythmia, and atrial flutter.
Fetal therapy may also be an option for a select group of structural heart defects, including aortic stenosis, pulmonary atresia, hypoplastic left heart syndrome, and Ebstein's anomaly.
What happens if my baby is a candidate for a fetal intervention/surgery?
If your obstetrician or cardiologist thinks your baby's heart defect may benefit from a fetal intervention you should call the Maternal Fetal Care Center at Boston Children's (617-355-3896). The Center will put you in touch with one of our cardiologists who will evaluate your situation.
Planning for birth
You will be referred to a local high-risk birthing center, such as Brigham and Women’s Hospital or Beth Israel Deaconess Medical Center for further perinatal care and delivery planning. Your baby’s cardiologist will be a part of your delivery team and will be available to you and your obstetrician to help manage your baby’s care before and after birth.
If specialized treatment is needed immediately after birth, delivering your baby at one of our obstetric hospitals allows for a smooth and timely transfer of your baby to Boston Children's . For most types of fetal heart defects, the mother can give birth naturally. In rare instances, the baby may need to be delivered by caesarian section. Our team will be there with you every step of the way to provide both clinical and support services to help you with newborn care and special family needs that may arise as a result of this difficult time.