Screening for congenital heart disease: a move toward earlier echocardiography

Fetal echocardiography remains the mainstay for diagnosis in those pregnancies identified to be at risk for congenital heart disease (CHD). Prenatal diagnosis of CHD remains essential to provide families with thorough pregnancy options as well as allow for transfer to facilities experienced in the management of pediatric cardiac disease in cases of ongoing pregnancy. First-trimester and early second-trimester fetal echocardiography is now feasible and will be increasingly in demand as enlarged nuchal translucency and first-trimester cystic hygroma are becoming common indications for early fetal echocardiography. Although the reported performance characteristics of early fetal echocardiography are good, the technique should be viewed as an adjunct to mid-trimester echocardiography, with its biggest benefit likely to be the ability to provide earlier reassurance to couples at risk for CHD. Early fetal echocardiograms should be reserved for patients at risk for CHD and be performed in centers experienced in this technique.