Fetal Cardiology Program
Conditions We Treat
We offer comprehensive care of all fetal conditions, and we are one of the only programs in the nation capable of providing the full scope of fetal therapies and innovative fetoscopic procedures. Listed below are the fetal cardiac conditions that are often seen and treated at our center.
Conditions
Absent pulmonary valve syndrome is a rare condition in which the pulmonary valve is either severely underdeveloped or missing, affecting blood flow. Usually associated with tetralogy of Fallot, absent pulmonary valve syndrome is marked by severe pulmonary insufficiency in utero and dilation of the pulmonary arteries. This syndrome can be associated with airway abnormalities that can cause respiratory problems.
An abnormality in the coronary arteries that supply blood to the heart muscle. The condition is usually congenital (present at birth), although it may not be diagnosed until adolescence. In some cases, the arteries don’t stem from the correct place, or there are problems with size or connections of the arteries.
Aortic coarctation and interrupted aortic arch is a condition in which there is a narrowing in the aorta or a gap in the artery, affecting blood flow. Interrupted aortic arch is a very rare heart defect that occurs when the aorta does not develop normally before birth.
Arrhythmias are abnormal heart rhythms that can affect the heart’s ability to pump blood effectively. Although relatively rare in children, arrhythmias can lead to significant health problems if not treated.
An ASD is often referred to as a “hole in the heart.” The condition occurs when there is an abnormal opening in the septum that divides the two upper chambers of the heart. This opening allows blood from either side of the heart to cross into the opposite atrium.
Atrioventricular canal defect (also known as atrioventricular septal defect or endocardial cushion defect) occurs when a large hole in the center of a child’s heart connects all four chambers. Normally, heart chambers are divided so that the oxygen-rich blood from the lungs does not mix, and extra blood gets pumped into lung arteries. This extra blood makes the heart and lungs work harder. Often there is an abnormal valve on the left side of the heart. The cause isn’t known, although canal defects are often associated with Down syndrome.
Aortic stenosis is a narrowing of the heart's aortic valve, which can make it difficult for blood to flow properly from the heart to the rest of the body. The aortic valve is 1 of 4 heart valves that keep blood flowing through the heart. The valves make sure blood flows in only one direction.
Aortopulmonary window is a rare heart defect in which there is an abnormal connection between the aorta and the pulmonary artery, leading to the mixing of oxygenated and deoxygenated blood.
An abnormal heart rhythm, atrial flutter causes the upper chambers of the heart (atria) to beat too fast, impacting the heart's ability to pump blood effectively.
This congenital heart defect is characterized by a hole in the center of the heart that allows blood to mix between the atria and ventricles.
A complex heart condition, Borderline left heart/Shone’s variant involves multiple abnormalities in the left side of the heart's structures. Borderline left heart can range from mild to severe. It consists of at least one left-sided heart defect, but sometimes a combination of several.
Bradyarrhythmia is a condition that causes the heart to beat too slowly, potentially causing decreased blood flow and oxygen delivery. Bradyarrhythmia is one of several types of fetal cardiac arrhythmias, congenital heart conditions involving an abnormal heartbeat. Arrhythmias can cause the fetal heart to beat too fast, too slow or irregularly.
Bradycardia causes a slow heart rate that may result in symptoms such as dizziness, fatigue, or fainting. What’s considered too slow depends on many factors, including your child’s age.
Cardiac tumors and masses are abnormal growths located in the heart, which can sometimes affect heart function.
Cardiomyopathy is a condition where the heart muscle becomes weak, enlarged or stiff, impacting the heart's ability to pump blood. Cardiomyopathy causes damage to tissue around the heart, as well as heart muscle cells. In severe cases, the heart becomes so weak that it can’t pump blood properly. Cardiomyopathy predominantly affects adults, but in rare instances affects infants and children.
CPVT is an inherited cardiac condition that causes sudden rhythm disturbances, called arrhythmias, in otherwise healthy children. These abnormal rhythms most often occur at times of high adrenaline levels, such as during exercise.
Coarctation of the aorta is a heart defect that is usually present at birth (congenital). The condition causes a narrowing of the aorta, the main blood vessel that carries oxygen-rich blood from the heart to the body. A child with greater narrowing of the aorta will have more symptoms.
Congenital aortic stenosis is a narrowing of the aortic valve present from birth, causing difficulties with blood flow. Aortic stenosis is a condition that causes the blocking of blood flow between the left ventricle and the aorta.
Congenital coronary anomalies refer to any abnormalities in the coronary arteries that supply blood to the heart.
A condition that disrupts the electrical signals in the heart, congenital heart block can lead to an abnormal heart rhythm.
Congenitally corrected transposition of the great arteries is a rare heart defect in which the two main arteries of the heart are switched, disrupting blood circulation. In a normal heart, the left-side pumping chamber (left ventricle) sends blood to the entire body. The right-side ventricle pumps blood only a short distance, to the lungs.
Double inlet left ventricle is a complex heart defect in which both the atria of the heart connect to the left ventricle, instead of each atrium connecting to a separate ventricle. The ventricles are the heart’s pumping chambers. Babies with double inlet left ventricle are left with only one developed or working pumping chamber (the left ventricle). Treatment typically involves a series of two or three heart procedures within the first few years of life.
Double outlet right ventricle is a heart defect in which both the aorta and pulmonary artery arise from the right ventricle, leading to improper blood flow. In babies with this condition, the heart must work harder than normal to pump enough oxygenated blood out into the body, which can cause the heart to become enlarged. Too much blood may also be pumped to the baby’s lungs. Without treatment, risks include high blood pressure and heart failure.
Ebstein’s anomaly is a rare condition where the tricuspid valve is displaced and doesn't function properly. Ebstein’s anomaly has a wide range of severity, from mild to severe. It has been associated with exposure to certain medications during pregnancy (such as lithium), but in most cases the cause is unknown. Newborns with Ebstein’s anomaly may show signs of the condition within the first few days or weeks after birth.
Ebstein’s anomaly and dysplastic tricuspid valve condition where the tricuspid valve in the heart is malformed, affecting blood flow between the chambers.
This is a rare condition in which the heart is located outside the chest cavity or has a defect that causes the chest wall to be incomplete.
Eisenmenger syndrome is a heart defect that leads to increased pressure in the lungs, causing long-term complications. Symptoms tend to develop during puberty or early adulthood and may include exercise intolerance and heart rhythm abnormalities.
Endocarditis is an infection of the heart’s inner lining or valves. Usually caused by a bacterial infection, endocarditis inflames the lining of the heart valves and chambers. Treatment includes medications and sometimes surgery.
Heart failure is a condition in which the heart is unable to pump blood effectively, leading to various symptoms. Heart failure does not mean that the heart has stopped working but instead that it isn’t working as well as it should.
Heart murmurs are abnormal heart sounds that may indicate an underlying heart condition. Some heart murmurs go away on their own with time. If the murmur is from a congenital heart defect, treatment may include medication or surgery.
Heterotaxy syndrome is a disorder where the internal organs are not arranged in the usual way within the body or are missing. Many children with heterotaxy syndrome have complex congenital heart defects, which can make the condition challenging to treat.
An abnormal heart rhythm, fetal cardiac arrhythmia can be detected in the fetus during pregnancy.
Genetic disorders associated with cardiac disease include:
DiGeorge/Chromosome 22q11.2 deletion syndrome
Noonan syndrome
Trisomy 13
Trisomy 18
Trisomy 21
Turner syndrome
HLHS is a congenital heart defect in which the left side of the heart is underdeveloped, affecting blood circulation. The mitral valve, the left ventricle and the aortic valve are too small, and not enough blood pumps through the left side of the heart to support the rest of the body. HLHS may be diagnosed by routine ultrasound during pregnancy, usually at 18–20 weeks. Other tests, such as fetal echocardiography, are usually needed to confirm a diagnosis and to learn more about the defect.
A rare defect in which the aorta is not fully developed, causing a gap in the main artery that carries blood from the heart.
Ineffective endocarditis is a serious infection of the heart’s inner lining that often does not respond well to treatment.
Inherited arrhythmia syndromes are genetic conditions that can cause abnormal heart rhythms. These inherited arrhythmia syndromes include long-QT syndrome, catecholaminergic polymorphic ventricular tachycardia and Brugada syndrome.
Kawasaki disease is a condition that causes inflammation of blood vessels, including those around the heart. The condition most often affects kids younger than 5 years old. When treated early, children with Kawasaki disease begin to feel better within a few days.
Long QT syndrome is a genetic disorder that can cause fast, chaotic or irregular heart rhythms. The term “long QT” refers to the pattern seen on an EKG.
Multilevel left-heart hypoplasia is a heart defect characterized by underdeveloped structures on the left side of the heart. Babies born with hypoplastic left heart syndrome can’t pump blood well on the left side of the heart. Instead, the right side of the heart must pump blood to the lungs and to the rest of the body.
Myocarditis is inflammation of the heart muscle that can lead to cardiomyopathy (weakening of the heart muscle). Myocarditis can be caused by viral infections or other inflammatory conditions such as autoimmune disorders. In severe cases of myocarditis, the heart muscle weakens and cannot pump blood effectively to other parts of your body.
Maternal lupus/SSA disease is a condition in which a mother’s immune system attacks the fetus’s heart, leading to heart problems. Neonatal lupus is a rare acquired autoimmune disorder that is present at birth (congenital). Affected infants often develop a red rash or skin eruption.
Partial anomalous pulmonary venous return refers to abnormal connections between the pulmonary veins and other parts of the body. It affects the flow of oxygen-rich blood from your lungs to your heart. Your pulmonary veins normally return all freshly oxygenated blood to the left side of your heart. But in PAPVR, they deliver some of this blood to the right side, which should only hold oxygen-poor blood.
PDA is a persistent opening between two major blood vessels leading from the heart. PDA is an extra blood vessel found in babies before birth and just after birth. In most babies who have an otherwise normal heart, the PDA will shrink and close on its own within first few days of life. If it stays open longer, it may cause extra blood to flow to the lungs.
Pericarditis refers to inflammation of the lining around the heart, the pericardium. This is the thin sac that surrounds the heart. The pericardium holds the heart in place and helps it work right.
Pericardial effusion is a buildup of fluid around the heart, which can put extra pressure on the heart and affect its function. If untreated, it may lead to heart failure.
A premature atrial contraction is an extra heartbeat that occurs in the heart’s upper chambers, disrupting the normal heart rhythm. Premature atrial contractions are the most common type of fetal cardiac arrhythmias, congenital heart conditions involving an abnormal heartbeat. Arrhythmias can cause the heart to beat too fast, too slow or in this case, irregularly. In most cases, premature atrial contractions aren’t harmful to the baby and typically resolve on their own.
A condition where the pulmonary valve, which controls blood flow to the lungs, is abnormally closed, leading to restricted blood flow. Babies born with pulmonary atresia are unable to survive without medication and eventual intervention or surgery, as they lack the proper connection between the right side of the heart and the lungs. Babies born with pulmonary atresia don’t have enough oxygen in their blood to support the body’s needs.
Pulmonary atresia with intact ventricular septum is a congenital heart defect in which the pulmonary valve doesn’t form properly, and the right ventricle and tricuspid valve don’t fully develop. Babies born with pulmonary atresia don’t have enough oxygen in their blood to support the body’s needs. Treatment at birth is necessary for survival.
A narrowing of the pulmonary valve, pulmonary stenosis can impede blood flow from the right ventricle to the lungs. Symptoms of pulmonary stenosis depend on how small the narrowing of the pulmonary valve is. If symptoms are mild, pulmonary stenosis may never need treatment.
Rheumatic heart disease is a complication of rheumatic fever that can cause long-term heart valve damage. Rheumatic fever is an inflammatory disease that begins with strep throat. Typically, this long-term damage happens to the mitral valve, aortic valve or both. This damage may cause a valve to “leak” or become narrow over time.
Right-ventricular outflow tract obstruction is a blockage in the pathway between the right ventricle and the pulmonary artery.
SVT refers to episodes of rapid heart rate originating from above the ventricles, potentially causing palpitations or discomfort. SVT affects the heart's upper chambers. The typical heart beats about 60 to 100 times a minute. A heart rate of more than 100 beats a minute is called a tachycardia. During an episode of SVT, the heart beats about 150 to 220 times a minute.
Secondary heart conditions are heart conditions caused by other medical conditions and include:
- Absence of the ductus venosus: the ductus venosus connects the portal and umbilical veins with the inferior vena cava and acts as a sphincter to protect the fetus from placental over circulation. Its absence is associated with chromosomal anomalies and congenital malformations.
- Congenital diaphragmatic hernia: a hole or opening in the baby’s diaphragm, the muscle that separates the abdomen from the chest. This defect allows the abdominal organs, such as the stomach, intestine, liver and spleen, to move up into the chest cavity.
- Gastroschisis: a hole in the abdominal wall of the fetus that allows the intestines to protrude outside of the baby’s body, where they are exposed to the amniotic fluid.
- Hydrops: fetal hydrops, or hydrops fetalis, is a serious condition in which fluid builds up in two or more areas of the baby’s body, causing severe swelling.
- Omphalocele: a defect in the baby’s abdominal wall that allows the intestines and other organs to protrude outside of the body, through the navel.
- Sacrococcygeal teratoma: a tumor, or mass, that forms on the baby’s tailbone during fetal development. The tumor may be external, growing on the outside of the fetus, or internal, growing inside the body.
- Twin-twin transfusion syndrome: a serious condition that occurs in about 10–15% of pregnancies with identical twins that share one placenta.
Subaortic stenosis is a narrowing beneath the aortic valve that can obstruct blood flow. Subaortic stenosis is a blockage or narrowing at the outlet of the left ventricle, just below the aortic valve that makes it hard for the left ventricle to pump blood to the body.
Supravalvar aortic stenosis is a narrowing of the aorta above the aortic valve, restricting blood flow. Supravalvar aortic stenosis is an uncommon vascular defect that usually develops in the first few years of life.
Syncope refers to a temporary loss of consciousness or fainting that can occur when not enough blood gets to the brain. Syncope is commonly called fainting. In most children, it’s usually harmless.
Abnormally fast heart rhythms that can lead to palpitations, dizziness or fainting. In some cases, the fast heartbeat may also have an irregular rhythm. Tachyarrhythmia is one of several types of fetal cardiac arrhythmias, congenital heart conditions involving an abnormal heartbeat. The condition is also sometimes referred to as tachycardia.
TOF is a congenital heart defect characterized by four heart abnormalities that affect blood flow. TOF is a complex congenital heart condition that involves four defects in the heart’s structure. These defects change the normal flow of blood through the heart, causing oxygen-poor blood to flow out of the heart and into the body. The condition occurs during the first eight weeks of pregnancy when the fetal heart fails to develop correctly. Babies born with TOF require heart surgery within the first year of life.
Total and partial anomalous pulmonary venous return is a condition in which the pulmonary veins do not connect properly to the heart, leading to abnormal blood flow.
Transposition of the great arteries is a heart defect in which the positions of the two main arteries carrying blood from the heart are switched, affecting blood circulation.
Tricuspid atresia is a heart defect in which the tricuspid valve is missing or abnormally developed, causing problems with blood flow. Tricuspid atresia is a congenital heart defect that often causes serious symptoms soon after birth because blood flow to the lungs is less than normal.
Truncus arteriosus rare heart defect in which there is a single large blood vessel arising from the heart, instead of separate arteries. Normally there are two main blood vessels leaving the heart. A baby with truncus arteriosus has only one great blood vessel or trunk leaving the heart. It then branches into blood vessels that go to the lungs and the body.
A vascular ring occurs when a child's aorta or its branches form abnormally, encircling and constricting the trachea and esophagus, leading to breathing and swallowing issues. There are three main types of vascular rings: double aortic arch, right aortic arch and left aortic arch.
Ventricular septal defect and tachycardia is a common heart defect in which there is a hole in the wall separating the two lower chambers (ventricles) of the heart. Ventricular tachycardia is a fast and abnormal heart rhythm that originates from the ventricles, potentially causing serious symptoms.
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