Prenatal screening for structural congenital heart disease

Prenatal diagnosis of congenital heart disease (CHD) is important for investigation of affected fetuses for comorbidities, prognostication, preparation for postnatal management, and parental choice about continuation of pregnancyHistorical risk factors, such as a family history of CHD, or fetal risk factors, including increased nuchal translucency, warrant investigation with detailed fetal echocardiographyMost fetuses with CHD present in the 'low-risk' population, and prenatal detection depends on recognizing abnormalities during obstetric scansCardiac anomalies characterized by an abnormal four-chamber view of the heart have a higher detection rate than those in which the abnormality is primarily of the outflow tractsFor particular cardiac lesions, including transposition of the great arteries, coarctation of the aorta, and hypoplastic left heart syndrome, prenatal diagnosis improves outcomesPrenatal diagnosis of CHD allows the preparation of postnatal intervention in most instances; in a minority of cases (mainly critical left-heart lesions), fetal cardiac intervention can be considered