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Congenital heart disease is the most frequent neonatal malformation, with an estimated prevalence between 0.8% and 1%. Echocardiography is an important tool for diagnosis and follow-up in cardiology, because it is easy to use, inexpensive, and noninvasive. The study of fetal heart by means of echocardiography allows early diagnosis and treatment of fetal heart anomalies and dysfunction, and such a technique is increasingly used. This exam is often required after morphological fetal echography, when a congenital heart disease is suspected or when there is an increased risk of congenital heart disease. Fetal echocardiography allows to evaluate the cardiac anatomy and function or cardiac rhythm. The purpose of this review is to summarize the main parameters and echocardiographic techniques for the assessment of heart rhythm and function: two-dimensional echocardiography, Doppler, tissue Doppler, and two-dimensional strain.

Heart failure (HF) in pediatric patients shows many differences from adult HF because of biochemical and ultrastructural peculiarity due to contractility modifications for different loading conditions, often resulting from congenital heart diseases. The majority of heart diseases in pediatric patients with symptoms and signs of HF are due to severe heart diseases (such as ventricular septal defect, severe aortic stenosis, aortic coarctation syndrome). There are several reasons for early HF in the natural evolution of congenital and acquired heart diseases. They are of hemodynamic nature (pressure and volume overloading, reduced ventricular compliance), or due to systolic ventricular dysfunction. In order to optimize the medical and/or surgical treatment in these conditions an immediate etiological and pathophysiological evaluation should be done. In this regard the echocardiographic technique allows to reach a rapid and accurate diagnosis and a good therapeutic view in a non-invasive and easily to repeat way.