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There is a growing body of knowledge regarding the integration of multiple imaging modalities into the care of fetuses with aortic arch anomalies. This study aims to present our experience and fetal cardiac output data from a cohort of patients with discrete aortic coarctation and aortic arch hypoplasia. Methods/Results Retrospective review identified 25 fetuses with discrete aortic coarctation ( n = 8) or aortic arch hypoplasia ( n = 17) (with mean gestational age at diagnosis, 27.2 weeks; at birth 37.6 weeks). Mean combined ventricular output in all fetuses with normal ventriculo-arterial concordance was 383 ml/min/kg (median 362) with mean R:L cardiac output ratio of 2.83 (median 2.13). Of 23 neonates with primary surgical arch repair, all 7 with discrete coarctation underwent lateral thoracotomy without re-intervention. Of 16 with arch hypoplasia, 10 underwent primary lateral thoracotomy (3 with re-intervention) and 6 underwent primary sternotomy (1 with re-intervention). Of 2 with mild coarctation without primary repair, one with coexistent severe LV dysfunction underwent stenting and dilatation; the other is followed in the context of transposition of the great arteries status post arterial switch. Pre-op CT and 3D cardiac printing were obtained in 19 neonates. During follow-up, five (20%) had systemic hypertension. Conclusion Fetal R:L cardiac output ratio may provide complementary hemodynamic information in prenatal diagnosis of aortic arch anomalies. As expected, characterization of arch conformation remains critical for surgical planning. Pre-operative cardiac CT remains a useful adjunct to delineate arch anatomy for surgical planning purposes but may not reduce re-intervention by itself. Benefit of 3D cardiac printing remains difficult to quantify but has become an invaluable tool for family education. Based on our data, neonates with arch hypoplasia may benefit from midline sternotomy for more extensive surgical exposure and potentially reduced re-intervention rate. [ABSTRACT FROM AUTHOR]

Congenital heart disease occurs in approximately 1% of all live births and accounts for 30–50% of all infant mortality due to congenital malformations. Infant mortality related to congenital heart disease has significantly decreased over the last 20–30 years due to improvement in surgical procedures, introduction of interventional procedures, and more accurate ultrasonic and advanced imaging diagnostic studies. With the multifactorial improvement in mortality outcomes, it is difficult to demonstrate a survival benefit for infants based on prenatal diagnosis of congenital heart disease alone. However, prenatal diagnosis of congenital heart disease is associated with significant improvement in postnatal morbidity including reduced duration of mechanical ventilation, length of hospital stay, end organ dysfunction, and improvement in neurodevelopmental outcomes. Additionally, there is still considerable variation in mortality outcomes across races and geographical locations within the United States with increased mortality associated with increased distance from top pediatric cardiac surgical centers. This paper describes a comprehensive perinatal cardiology program model at a stand-alone children's hospital with a referral base that encompasses a large geographical region of the state with variable limitations in access to tertiary care. A comprehensive perinatal cardiology program with a multispecialty team of fetal cardiologists, maternal fetal medicine physicians, nurse coordinators, pediatric cardiology subspecialists, and supportive services for patients with wide and diverse community partnerships is an essential component in providing accessible prenatal cardiac care and complex delivery planning regardless of socioeconomic status or geographical location, limiting disparities in care and improving overall outcomes. • Congenital heart disease accounts for 30–50% of all infant mortality due to congenital malformations. • Prenatal diagnosis of congenital heart disease is associated with reduced morbidity such as: duration of mechanical ventilation, length of hospital stay, end organ dysfunction, and improvement in neurodevelopmental outcomes. • Development of perinatal cardiac centers with access to maternal fetal medicine, high risk obstetrical, neonatology and pediatric cardiology as well as other pediatric subspecialties is vital for the management of infants with critical congenital heart disease. [ABSTRACT FROM AUTHOR]

Critical congenital heart disease is the target of postnatal, pulse-oximetry screening; nevertheless, prenatal detection is preferable. Prenatal diagnosis allows for advanced perinatal planning, parental counseling, potential fetal cardiac intervention if indicated, and avoidance of complicated, costly, and at times, risky neonatal transport. The purpose of this study was to investigate a possible association between the occurrence of critical congenital heart disease and pregnancies complicated by maternal comorbidities. We identified all those prenatally and postnatally diagnosed with critical congenital heart disease in Nevada between July 2014 and June 2020. For each identified case of critical congenital heart disease, we assessed each mother's medical history. We divided pregnant women into two groups: 1) those with maternal comorbidities and 2) those without comorbidities. We identified 367 cases of critical congenital heart disease. Of the 367, 229 (62%) occurred in those with maternal comorbidities. Of the 367, 321 (87%) were live-born. Of the 321 live-born, 201 (63%) occurred in those with maternal comorbidities, however, the prevalence of maternal comorbidities in the general pregnancy population is not known. The majority of patients born with critical heart disease were born to mothers with comorbidities versus those without comorbidities for both the total and live-born cohorts (p = 0.00001). Of the 321 live-born, 10 had no prenatal care. Of the 311 with prenatal care, 248 (80%) were prenatally diagnosed. During the study period, there were approximately 210,000 live births in Nevada, for a prevalence of 15.2 (321/210,000) critical congenital cardiac malformations per 10,000 live births. In Nevada, most of those with critical congenital heart disease are products of pregnancies complicated by maternal comorbidities. Further, the state -wide, live-born, critical congenital heart disease prenatal-detection rate was 80%. • Prenatal detection of critical congenital heart disease is preferred to postnatal diagnosis. • The majority of patients born with critical heart disease were born to mothers with comorbidities. • In Nevada, critical congenital heart disease prenatal detection rate is 80%. [ABSTRACT FROM AUTHOR]

The purpose of this study was to determine the yield of fetal echocardiography based on indications for referral and to establish the incidence of structural heart disease noted in a diverse urban population. A retrospective review of our Pediatric Echocardiography Laboratory database was undertaken from March 2010 to June 2014. Demographic information, indications for referral and prenatal diagnoses were recorded. The diagnosed cardiac anomalies were classified into structural and rhythm abnormalities and the former was divided into major and minor anomalies. We compared the number of fetal echocardiograms performed during this four-year period to a similar four-year period, a decade earlier. Also, we compared the number of cardiac admissions to the neonatal intensive care unit in these two periods. 3623 fetal echocardiograms were performed on 2953 patients between 2010 and 2014. Fetal indications accounted for 70% of referrals. Overall, yield of congenital heart disease was 11.5%; 6.8% from maternal and 13.4% from fetal indications. Abnormal obstetrical fetal ultrasound was associated with congenital heart disease in 13.9% of cases. Of 336 fetuses with congenital heart disease, 119 were major and 47 were critical. 80% of all congenital heart diseases (273 of 336) and 90% of major and critical heart disease were found in those referred for fetal indications. Approximately half (24 of 47, 51%) of the critical congenital heart disease involved defects with varying degrees of left heart hypoplasia. Compared to a previous period, there was an increase in FE and neonatal intensive care unit admissions with cardiac diagnoses. However, critical congenital heart disease detected postnatally fell from 28.8 to 12.8% (P = 0.001). Yield of fetal echocardiograms is higher for fetal versus maternal indications. At our center, increase in prenatal detection of critical congenital heart disease may have resulted in reduction in congenital heart disease diagnosed in the neonatal intensive care unit. [ABSTRACT FROM AUTHOR]

Congenital heart diseases (CHD) are dynamic defects that originate in the embryo, evolving during gestation, and undergoing significant change throughout the entire course of extrauterine life. CHD represent a complex group of abnormalities related to high infant morbidity and mortality. Ultrasonography advances in Obstetrics and Fetal Medicine have contributed to the increased detection of these anomalies, with high screening potential during pregnancy. Despite studies pointing to high fetal echocardiography's sensitivity and specificity, this method is not homogeneously available worldwide yet, particularly in low and medium-income countries. Here we compared the accuracy of obstetric ultrasonography performed between 18 and 22 weeks of gestational age with Fetal Echocardiography. We evaluated 44 pregnant women who underwent fetal echocardiography examination. This way, we can comprehend if the first method alone can diagnose fetal cardiac abnormalities or track those that need additional imaging by fetal echocardiography. In our sample, Obstetric Ultrasonography reached 81.8% accuracy, 57.1% sensitivity, and 93.3% specificity, whereas Fetal Echocardiography's accuracy was estimated at 97.7%, 100% sensitivity, and 96.8% specificity. Despite the superior accuracy of Fetal Echocardiography, we believe that Obstetric Ultrasonography is enough to establish a probable diagnostic hypothesis when performed by experienced professionals, following the specific guidelines. This way, appropriate referral to tertiary centers can facilitate the care of these infants with complex heart disease that requires aggressive surgical intervention and Neonatal and Cardiac Intensive Care services. • Congenital heart diseases (CHD) are a complex group of structural malformations and physiological alterations related to high infant morbidity and mortality. • Advances in ultrasonography scan in Obstetrics and Fetal Medicine Ultrasonography has contributed to the increase in detection of structural cardiac anomalies, consisting of great potential for screening even during pregnancy. • Although Fetal Echocardiography is considered superior to Obstetric Ultrasonography for antenatal congenital heart disease diagnosis, this method is not homogeneously available worldwide yet. • The Ultrasonography performed by an experienced professional, can be a useful instrument in screening of congenital heart disease. [ABSTRACT FROM AUTHOR]

Controversy exists regarding an association between advanced maternal age and the occurrence of fetal congenital heart disease and whether advanced maternal age is an indication for fetal echocardiography. Our purpose was to undertake a retrospective, multi-year review of critical congenital heart disease in Nevada to investigate a possible association with advanced maternal age. We identified all those prenatally and postnatally diagnosed between September 2012 and August 2020. For each identified case, we tabulated each pregnant woman's age at the estimated date or actual date of delivery. Using Nevada population demographic data, we calculated the percentages of pregnant women ≥ 35 years old (defined as advanced maternal age) and of pregnant women < 35 years old. Subsequently, we calculated occurrence rates for critical congenital cardiac malformations in advanced and non-advanced maternal age populations. A chi-square risk ratio analysis, excluding aneuploidy cases, was used to determine statistical significance for each malformation. We identified 467 total cases. Of the 467, 39 (8.4%) had aneuploidy. Of the 467, 413 (88.4%) were live born, 32 (6.9%) had fetal demise, and 22 (4.7%) had elective termination. There were approximately 280,000 live births during the study period for a prevalence of 14.8 cases (inclusive of both those with and without aneuploidies) per 10,000 live births. From the 428 cases exclusive of aneuploidy, the following malformations were statistically significantly associated with advanced maternal age (risk ratios with 95% CI): 1) coarctation ± ventricular septal defect 1.75 (1.12, 2.73) p = 0.01, 2) D-transposition of the great arteries ± ventricular septal defect 2.13 (1.18, 2.83) p = 0.01, 3) double outlet right ventricle 2.10 (1.01, 4.35) p = 0.04, and 4) tetralogy of Fallot ± pulmonary atresia 2.40 (1.39, 4.31) p = 0.001. Excluding aneuploidy cases, advanced maternal age was statistically significantly associated with some critical congenital cardiac malformations and lacked association with others. • Advanced maternal age is associated with selected critical congenital cardiac malformations • Advanced maternal age as an indication for fetal echocardiography may improve the detection of critical heart diseases • Robust program database management may obviate a reliance on third-party registries [ABSTRACT FROM AUTHOR]

Abstract: Fetal echocardiography has provided us with a valuable opportunity; a clear window to observe the events of maturation and development in the human fetus. The well-rounded pediatric/fetal cardiologist caring for the unborn patient must ideally be aware of all forms of prenatal disease which can potentially affect the fetus, and not just be able to detect the presence of congenital heart disease. In this chapter, we review three such examples of disorders which can affect the fetal cardiovascular system: (1) volume loading anomalies, (2) intrathoracic masses, and (3) the twin–twin transfusion syndrome. Each of these disorders manifests very unique influences and affects the fetal cardiovascular system. [Copyright &y& Elsevier]

Abstract: Hypoplastic left heart syndrome encompasses a diverse group of heart defects that share the common feature of underdevelopment of the left heart. There are multiple anatomic substrates involved in the development of hypoplastic left heart syndrome, as well as variants of classic hypoplastic left heart, that may signify unique risks and benefits. Additionally, other functional and anatomic cardiac findings as well as extracardiac anomalies are frequently associated with hypoplastic left heart syndrome and have significant impact on outcome. Through a careful, systematic approach, fetal echocardiography can detect many of the anatomic and functional details that contribute to outcomes. Detailed fetal ultrasound and fetal karyotype will diagnose many of the non-cardiac lesions that can be found with hypoplastic left heart syndrome. Parents must also be counseled of risk factors that may not be detected in utero. Knowledge of the specific diagnostic features that can affect outcome allows the fetal cardiologist to obtain all the necessary details, and provides the most accurate assessment of probable outcome in each individual patient. [Copyright &y& Elsevier]

Abstract: During the past 25years fetal echocardiography has evolved from a research tool to a clinical tool used by obstetricians, maternal–fetal medicine specialists, radiologists, and pediatric cardiologists. Each group of physicians faces different tasks. The non-pediatric cardiologist is primarily involved with screening for heart defects in low-risk patients while the pediatric cardiologist is charged with the delineation of complex fetal heart defects. Both tasks can be challenging. With the introduction of 3D and 4D fetal echocardiography, a number of modalities are available to assist the non-cardiologist when performing the screening examination of the fetal heart that includes evaluation of the four-chamber and the outflow tract views of the fetal heart. These include the “spin” technique and the evaluation of tomographic imaging planes. Using similar techniques the pediatric cardiologist can render 3D and 4D views of the heart that are equivalent to anatomical models of the heart, as well as examine 2D image planes derived from 3D and 4D datasets that assist in identifying the nine image planes that have been defined for fetal echocardiography. [Copyright &y& Elsevier]

Abstract: Heterotaxy syndrome, a disorder that involves abnormal lateralization of the abdominal viscera, thoracic organs and cardiac atria, remains one of the most challenging lesions in the field of pediatric cardiology both from a diagnostic and surgical strategy standpoint. Despite improved techniques, heterotaxy syndrome continues to be associated with high morbidity and mortality. Generally, heterotaxy syndrome can be categorized into two subtypes. Right atrial isomerism is associated with single ventricle, atrioventricular canal defect, pulmonary outflow obstruction, conotruncal abnormalities, bilateral superior vena cavae and total anomalous pulmonary venous connection. Left atrial isomerism can have similar intracardiac findings but also includes interruption of the inferior vena cava, ipsilateral pulmonary venous connection and complete heart block. Non-cardiac abnormalities such as splenic dysfunction, intestinal malrotation, and biliary atresia can be seen in both subtypes. Prenatal diagnosis of heterotaxy syndrome requires thorough knowledge of the typical findings as well as a systematic approach to the segmental anatomy. Accurate prenatal diagnosis is helpful to appropriately counsel families and for the perioperative management of these patients. However, the impact of prenatal diagnosis on long-term outcome remains to be seen. [Copyright &y& Elsevier]

Abstract: In this chapter we review the current status of early detection of congenital heart disease in the first trimester of pregnancy. There is an increasing demand for earlier diagnosis of congenital heart disease. Early fetal echocardiography is feasible and there are a number of complex diagnoses that can be made in early pregnancy. At present a follow-up second trimester ultrasound is required in all cases of on-going pregnancies. Early fetal echocardiography should be considered for fetuses at risk. For fetuses with an increased NT measurement, early fetal echocardiography should be reserved for those with a normal karyotype. Routine screening for structural heart disease should continue to be performed in the second trimester. Programs specializing in the early diagnosis of congenital heart disease should be confined to a small number of highly specialized institutions. [Copyright &y& Elsevier]

Abstract: Fetal blood flow is influenced by multiple factors, including the structure of the heart and the impedance of the distal vascular beds. Many babies with congenital heart disease have restricted intrauterine growth, neurologic abnormalities, and poor neurodevelopmental outcome, independent of surgical intervention. The circulatory alterations that accompany specific anatomic cardiac defects may lead to predictable blood flow disturbances that affect normal brain development. Doppler measurements of vascular resistance in the cerebral circulation and calculations of resistance ratios that quantitate fetal blood flow distribution are altered in growth retarded fetuses and are predictive of growth retardation and poor perinatal outcome in high risk pregnancies. Fetuses with normal hearts but compromised placental perfusion have a compensatory redistribution of blood flow that is believed to enhance cerebral perfusion. This phenomenon, termed “brain sparing”, is due to a decrease in cerebral vascular resistance, which is likely initiated and controlled by an autoregulatory mechanism. Failure of this mechanism to adequately compensate for cerebral hypoxemia in fetuses with congenital heart disease may result in the disproportionate intrauterine growth and neurodevelopmental abnormalities that occur in many of these infants. Investigators have only begun to study whether “brain sparing” occurs in fetuses with congenital heart disease and to determine if alterations in cerebral perfusion impact on fetal neurodevelopment and postnatal neurologic outcome for these high-risk infants. [Copyright &y& Elsevier]

Abstract: Doppler echocardiography has become an integral component to the assessment of fetal hemodynamic status, and can be utilized to assess fetuses with cardiovascular compromise due to a variety of cardiac and non-cardiac causes. As many of the conditions associated with fetal cardiac compromise now have fetal therapeutic options, understanding and identifying fetal cardiac dysfunction in the current era assumes even greater importance, because accurate description of cardiac natural history should become an important component in determining patient selection and timing of intervention. There are now a number of Doppler indices that can be readily obtained on fetal echocardiography which describe systolic and diastolic cardiac function. Classically, Doppler characterization of systemic venous and arterial flow—in the inferior vena cava, ductus venosus, umbilical vein and artery, and middle cerebral artery—have been utilized to identify changes associated with elevations of central venous pressure and changes in vascular flow distribution. More recently, the Doppler myocardial performance index has emerged as a promising new index for assessment of global systolic and diastolic ventricular function. Doppler myocardial tissue imaging is a new modality that also offers significant potential for assessing both fetal systolic and diastolic ventricular function. It is the purpose of this chapter to review the various Doppler methods of assessing fetal cardiovascular status, describe the changes in these indices that are characteristic of fetal cardiac compromise, and offer a clinical approach to the comprehensive assessment of fetal cardiovascular function. [Copyright &y& Elsevier]

Velocardiofacial syndrome (VCF) and other 22q11.2 deletion phenotypes can be diagnosed in utero by fluorescence in situ hybridization (FISH) of metaphase or interphase chromosomes from fetal cells obtained at 10–12 weeks by chorionic villus sampling or after 12 weeks by amniocentesis. Definite indications for prenatal testing are a family history of VCF or a 22q11.2 deletion, or ultrasound findings of a conotruncal cardiac defect. Other ultrasound findings reported with, but not specific to the 22q11.2 deletion, are: renal anomaly, polyhydramnios and, in the 10–12 week fetus, increased nuchal translucency. Further, evaluation of the fetus with confirmed or suspected 22q11.2 deletion includes karyotype, comprehensive initial and sequential ultrasounds and echocardiograms including a postnatal echocardiogram, as well as parental testing by FISH. If a deletion is identified, the family should be counseled by a multidisciplinary medical team knowledgeable about the spectrum of clinical features as well as the limitations of prenatal testing for the 22q11.2 deletion. With antenatal diagnosis of VCF or other 22q11.2 deletion syndromes, the parents can make an informed reproductive decision and plan for the current and subsequent pregnancies. [Copyright &y& Elsevier]

Common arterial trunk is a relatively rare form of congenital heart disease. Echocardiography performed either during fetal life or postnatally allows accurate diagnosis of this lesion. The key feature is that of a single arterial trunk arising from the heart which gives rise to the aortic arch and the pulmonary arteries. This abnormality is usually associated with a ventricular septal defect but may sometimes be associated with other cardiac anomalies. It may also be associated with extracardiac anomalies including karyotype abnormalities. Thus, counseling after prenatal diagnosis is influenced by the extent of associated lesions, both cardiac and extracardiac. Even though the results of surgical repair have improved the outlook for fetuses diagnosed with this condition is worse than that reported in postnatal series. This is partly explained by a significant non surgical mortality. [Copyright &y& Elsevier]

Predicting clinical outcomes in prenatally diagnosed Tetralogy of Fallot remains a challenge. This multicenter study aimed to prospectively evaluate fetal echocardiographic parameters associated with early neonatal intervention (<60 days). Secondary outcomes included oxygen saturation <80% at delivery, prostaglandin need, and valve sparing vs transannular patch repair. Serial fetal echocardiographic measurements were obtained. Patients were followed through pregnancy until 12 months post-surgical correction. Stepwise selection of variables was performed to identify important associated risk factors. Binomial logistic regression was used to analyze the primary and secondary outcomes. Between 2009 and 2014, N = 54/79 were recruited at 24 weeks gestational age (range 21–29 weeks), 2 died in utero and 3 died postnatally. The pulmonary valve z-score was smaller in patients who underwent early intervention (−3.4 ± 1.1 vs. −2.5 ± 1.8; p =.044) and smaller pulmonary valve z score was associated with transannular patch (Odd ratio (OR) 1.9; CI 1.2–3.1; p =.008). Reversal of flow in the ductus arteriosus was associated with early intervention (OR 6.6; CI 1.4–38.3; p =.023). Patients with an underlying genetic syndrome were more likely to undergo early intervention (11/15 (73%) vs 7/36 (23%), p =.001). In conclusion, for this prospective cohort, reversed flow in the ductus arteriosus was the only factor significantly associated with early intervention with a lower pulmonary valve z-score being associated with transannular patch repair. Patients with a genetic syndrome were more likely to undergo an early intervention. • Predicting early outcomes in prenatally diagnosed tetralogy of Fallot remains a challenge. • Reversal in ductus arteriosus flow is associated with early intervention. • Lower pulmonary valve z-score is associated with a transannular patch repair. • Syndromic patients were more likely to undergo an early intervention. [ABSTRACT FROM AUTHOR]

Perinatal cardiovascular care has evolved considerably to become its own multidisciplinary field of care. Despite advancements, there remain significant gaps in providing optimal care for the fetus, child, mother, and family. Continued advancement in detection and diagnosis, perinatal care and delivery planning, and prediction and improvement of morbidity and mortality for fetuses affected by cardiac conditions such as heart defects or functional or rhythm disturbances requires collaboration between the multiple types of specialists and providers. The Fetal Heart Society was created to formalize and support collaboration between individuals, stakeholders, and institutions. This article summarizes the challenges faced to create the infrastructure for advancement of the field and the measures the FHS is undertaking to overcome the barriers to support progress in the field of perinatal cardiac care. • Progress in perinatal cardiology is challenged by the rarity of fetal cardiac disease, care variation, and barriers to collaboration. • The Fetal Heart Society was founded to formalize collaboration between the multiple disciplines in perinatal cardiac care. • The FHS facilitates interdisciplinary multicenter research, education and advocacy to provide optimal perinatal cardiac care. [ABSTRACT FROM AUTHOR]

Congenital heart disease is the most common congenital malformation and has significant impact on postnatal outcomes. Prenatal diagnosis is associated with improved infant morbidity and mortality. Advancements in fetal echocardiography and robust screening practices have significantly increased accuracy of prenatal diagnosis of congenital heart disease and other cardiovascular pathologies. Therefore, it is very important to develop a comprehensive fetal echocardiographic screening protocol as part of the prenatal cardiology assessment. This review is geared towards the novice perinatal cardiologist or fetal sonographer. We will highlight indications for fetal echocardiography, guide the reader through a basic screening fetal echocardiogram utilizing the segmental approach, and discuss delivery planning for various cardiac disorders, incorporating practices from our institution. • Fetal echocardiographic screening is most commonly performed at 18-22 weeks gestation • Prenatal diagnosis of congenital heart disease improves postnatal morbidity and mortality • A perinatal nurse coordinator that attends maternal-fetal-medicine and cardiology clinic visits with the mother is a wonderful asset as a central point of contact for the family and specialists. • With close collaboration of the maternal-fetal care team and continued monitoring with fetal echocardiography, a specialized delivery plan should be in place well before the expected due date. [ABSTRACT FROM AUTHOR]

The World Health Organization declared the novel coronavirus, or COVID-19, a pandemic in March 2020. Given the severity of COVID-19, appropriate use criteria have been implemented for fetal echocardiography. Screening low risk pregnancies for critical congenital heart disease has typically been a shared responsibility by pediatric cardiologists, obstetricians, and maternal fetal medicine (MFM). Currently, many of the fetal echocardiograms for low risk pregnancies for critical congenital heart disease have been deferred or cancelled with the emphasis on suspected abnormalities by MFMs and obstetricians. In this review, we discuss the literature that has been the basis of screening of low risk pregnancies by pediatric cardiologists. A new approach to more widespread usage of fetal tele-echocardiography may play a large part during COVID-19 and may continue after the pandemic. • Appropriate use criteria for fetal echocardiography have been implemented during the COVID-19 pandemic. • Pediatric cardiologists have deferred fetal echo for low risk pregnancies, emphasizing those with suspected abnormalities. • Current fetal echo guidelines highlight maternal, familial, and fetal risk factors, and the associated incidence of CHD. • Fetal tele-echocardiography and telehealth consultation may enhance the ability to provide care during and beyond COVID-19. [ABSTRACT FROM AUTHOR]