Evaluation and Management of Fetal Cardiac Function and Heart Failure

Two-dimensional (2D) and Doppler echocardiography has become both an essential component in the assessment of anatomic anomalies of the fetal heart and an important tool in the assessment of fetal cardiac function. Various techniques for assessing fetal cardiovascular function exist and can be used to characterize systolic and diastolic ventricular function and estimate fetal cardiac output. These techniques can be utilized to assess fetuses with cardiovascular compromise due to a number of cardiac and non-cardiac conditions, including twin-twin transfusion syndrome, high-cardiac output lesions such as fetal tumors and vascular malformations, and primary fetal cardiomyopathy. As many of these conditions can now be treated by a variety of fetal therapeutic techniques, it is now important to be able to understand and identify fetal cardiac dysfunction. Characterization of fetal cardiac dysfunction now has the potential to provide clinicians with the means to better select patients for intervention, predict outcome, and perform follow-up following fetal interventional procedures.