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This review presents a detailed discussion on recent trends in fetal cardiac imaging. Ultrasound technique which are most useful for clinical practice today and will likely change the approach to cardiac evaluation in the future are presented. [ABSTRACT FROM AUTHOR]

The article presents a scientific statement regarding ttelemedicine in pediatric cardiology by the American Heart Association. These include the use of telemedicine to bridge distances in any aspect of medicine, a specific application of technology to conduct clinical medicine at a distanc, the defination of telecardiology as ad application of telemedicine in the field of cardiology and tele-echocardiography and the clinical scenarios on fetal echocardiography and fetal cardiac monitoring.

This chapter describes the current evidence and recommendations for surveillance and delivery timing for multifetal gestations. Ultrasound surveillance should include early determination of chorionicity, anatomic survey for all twins with fetal echocardiography for monochorionic twins, and growth assessment every 4 weeks. Monochorionic twins should also undergo ultrasound surveillance for twin- twin transfusion syndrome every 2 weeks starting at 16 weeks. Weekly testing with nonstress tests or biophysical profiles is recommended at 32 weeks formonochorionic, diamniotic twins, and 34 weeks for dichorionic twins. If this surveillance is reassuring, optimal delivery timing is 36 weeks 0 days to 37 weeks 0 days for monochorionic, diamniotic twins, and 37 week 0 days to 38 weeks 0 days for dichorionic twins. Key words: multiple gestation, twins, delivery timing, fetal surveillance, fetal growth [ABSTRACT FROM AUTHOR]

The article offers information on the release of revision of the "2005 Training Guidelines for Pediatric Cardiology Fellowship Programs" by the Society of Pediatric Cardiology Training Program Directors (SPCTPD) and the Joint Council of Congenital Heart Disease collectively. Topics discussed include goals of pediatric cardiology training, a paradigm shift in medical education and responsibilities of the training programs.

Advances in both imaging technology and understanding of fetal cardiac disease have contributed to a dramatic increase in the sensitivity and specificity of fetal echocardiography over the last few decades. Fetal echocardiography now plays an important role in the prenatal evaluation of fetuses with known or suspected aneuploidy. In this article, specific situations in which fetal echocardiography has a part in noninvasive aneuploidy screening algorithms are discussed. [ABSTRACT FROM AUTHOR]

The article discusses the sufficiency and benefits of the application of a 4-chamber view for the identification of risk factors associated with the occurrence of congenital heart disease (CHD) in a fetus. Fetal weight and growth should be recorded with utmost concern for the inspection of the presence of any growth disorders in the children. A review of the developments that already have been made and those that are expected in the future is presented.

This article discusses a study which reviewed some of the developments in Doppler sonography that are relevant for obstetrical practice. One of the developments in ultrasound imaging is the ability to assess tissue deformation, which led to several clinical applications such as functional echocardiography. Another development is power Doppler imaging of regional perfusion.

Objective: This study aimed to accurately evaluate the prevalence and outcome of congenital heart disease (CHD) with small for gestational age (SGA)in consecutive newborns. Method: A prospective cohort study was conducted of a series of all livebirth newborns. Two-dimensional and color Doppler echocardiography were performed at 0-4 days of life in 6041 consecutive neonates who were born at Hamamatsu University Hospital, Japan, between May 2005 and April 2015. All newborns with CHD were followed up by echocardiography until a spontaneous resolution of all cardiac lesions occurred or they underwent surgery, received catheter intervention or died. Results: A total of 291 newborns were diagnosed with CHD, while 401 newborns were SGA. Among the newborns with CHD, 46 were SGA (SGA group) and 245 were not (non-SGA group). The prevalence of CHD in the SGA group was significantly higher than that in the non-SGA group (114.7 vs 43.4 per 1000 live birth, p<0.001). Ventricular septal defect was the most frequent cardiac abnormality in both groups. However, the incidence of severe defects in the SGA group was significantly higher than that in the non-SGA group (19.6% vs 7.8%, p=0.025). In addition, the rate of chromosomal or genetic abnormalities in SGA newborns (23.9%) was significantly higher than that observed in newborns without SGA (4.9%, p < 0.0001).Fourteen newborns (30.4%) in the SGA group and 24 newborns (9.8%) in the non-SGA group underwent surgical repair or catheter intervention for cardiac lesions during 6.7±3.3 years of follow-up. Spontaneous resolution of cardiac lesions was observed in 20 (43.5%) newborns in the SGA group and in 145 (59.2%) newborns in the non-SGA group. In the SGA group, the 5-year survival rate and 5-year invasive intervention-free rate were 90.9% and 63.6%, respectively. These rates were significantly lower in comparison to the non-SGA group (99.6% and 87.8%, respectively; log-rank test, p<0.0001). A logistic regression analysis that included clinical characteristics and echocardiographic parameters showed that SGA newborns exhibited a significantly increased risk ofinvasive interventionand death (adjusted OR, 8.22; 95% CI, 2.37-28.52; p=0.001). Conclusion: This study was conducted to prospectively elucidate the association between SGA and CHD in a large cohort of consecutive newborns by echocardiography. The prevalence of CHD in the present study was markedly higher in the SGA newborns. Furthermore, these neonates had a higher risk of mid-term mortality and invasive intervention in comparison to non-SGA newborns. [ABSTRACT FROM AUTHOR]

Accuracy of Fetal Echocardiography in Defining Anatomical Details of Fetal Cardiac Pathology in the Current Era Background: Enhanced ultrasound technology and improvements in prenatal detection have provided opportunities to fine-tune fetal cardiac diagnoses. We sought to determine the accuracy of fetal echocardiography in defining anatomical details of major structural fetal heart disease(FHD) Methods: We queried the fetal echo database at the University of Alberta to identify pregnancies with a major FHD diagnosis between 2007-2018. We excluded simple septal defects, minor valve abnormalities and isolated coarctation. FHD was divided into 12 major categories to examine differences within subtypes. Fetal echocardiography reports were compared to post-natal echocardiography or autopsy when available, to assess segmental anatomy. Differences were described according to the following categories:1) No difference between fetal and postnatal findings 2) Minor differences with no impact on outcome (left superior vena cava), 3) Minor differences that could make a minor difference to the delivery plan or surgery (e.g. vascular ring), 4) Major differences that could lead to a change in the course of pregnancy, delivery or surgical planning (e.g. ductal dependency); 5) Errors of categorization that did not alter surgical planning but could have changed counseling (e.g. associations with extra-cardiac pathology). Results: In the study period 744 pregnancies with major FHD were encountered of which 151 (20.3%) had pregnancy termination, 43(6%) intrauterine demise, 6(1%) were lost to followup. 524(71%) were liveborn. Of the 744, 542 (524 echo and 18 autopsy) had confirmation of full cardiac anatomy. Table 1 details the number of cases in whom differences were demonstrated. Conclusion: Fetal echocardiography in the current era is highly accurate with few serious errors. Delineating the anatomy of the outflow tracts in complex cardiac lesions remains a challenge [ABSTRACT FROM AUTHOR]

Introduction: Congenital heart disease (CHD) is largely sporadic and suggested to be largely mediated by non-Mendelian or complex genetics. We previously showed the efficacy of mouse mutagenesis in recovering recessive mutations causing CHD. Here we hypothesize the complex genetics of human CHD can be modeled in mice using a sensitized mutagenesis screen for dominant mutations causing CHD. Methods: C57BL/6J mice were mutagenized using ethylnirosourea, then mated with C57BL/6J mice to generate G1 males that were further mated to females harboring heterozygous "driver" mutation (Kif7, Anks6, Sap130) that can cause CHD when in homozygosity. The G2 fetuses generated by each G1 male were considered a pedigree and were ultrasound scanned (US) at E13.5-19.5 using a 40 MHz transducer with the Vevo2100 ultrasound system. Results: We US scanned 17,750 fetuses from 487 G1 pedigrees, yielding 123 fetuses with CHD from 90 G1 lines (Table 1A). Interestingly, the overall incidence of CHD (0.69%) is similar to that observed in the previous recessive mutagenesis screen (0.76%) (Table 1A). Surprisingly, no laterality mutants were recovered compared to the 2.2% recovered in the recessive screen (Table 1A). Regardless of the driver mutations, similar spectrum of CHD was observed (Table 1B). Besides VSD, the predominant CHD phenotype observed was double outlet right ventricle and overriding aorta (Fig.1) and atrioventricular septal defect (Table 1B). Conclusion: We showed the feasibility of using mice to model dominant mutations causing CHD. The incidence of CHD observed in the dominant screen was similar to that of the recessive screen, indicating the genetics of CHD in mice and human are similar. [ABSTRACT FROM AUTHOR]