Caring for your baby begins in the womb.

At your 20-week anatomy scan, your Ob/Gyn or maternal-fetal medicine (MFM) specialist will take detailed images of your baby. During this appointment you may learn your baby is at risk for a heart condition and that you need to see a fetal cardiologist.  Connecticut Children’s Dr. Ray Lorenzoni, Dr. Alicia Wang and Dr. Timothy M. Crombleholme, reveal five reasons your developing baby might need further testing.  Your baby may have one or more of these.

1. Your baby’s heart looks larger than normal

A large-looking heart on an ultrasound, also called “cardiomegaly” or “disproportion”, can happen for a few different reasons.  Although your baby’s heart may be normal, we like to take a closer look at enlarged fetal hearts because the cause could be:

  • A problem with the heart function or the blood flow through the heart.
  • A separate condition that affects the heart, including fetal anemia, thyroid disorders, kidney conditions, unusual blood flow outside the heart, etc.

> Related: What to Expect at Your Fetal Echocardiogram 

2. The blood vessels in your baby’s heart look irregular.

The blood vessels’ job is to carry blood from the heart and throughout the body.  Sometimes when your baby is developing in the womb, the heart’s blood vessels do not form properly. If your Ob/Gyn or MFM suspects this is the case, your fetal cardiologist will check for:  

  • Aortic coarctation—when the body’s main blood vessel is narrower than it should be, and might affect the baby immediately after birth. 
  • Transposition of the great arteries—when the two large blood vessels that carry blood to the body and to the lungs are switched. This disorder requires surgery shortly after birth. 
  • Vascular ring—when there are unusual or extra connections between the blood vessels in your baby’s heart.  A vascular ring might cause breathing or swallowing issues after birth. 

3. The heart valves look abnormal. 

Like the vessels, the valves play an important part in moving blood in the right direction throughout the body. The four valves of the heart have delicate flaps that open and close.  If your OB/Gyn or MFM thinks the valves look unusual or the flaps are not moving correctly, they’ll refer you to a fetal cardiologist to check for: 

  • Valve dysplasia—when a heart valve is too thick or not formed correctly.
  • Valve stenosis—when a heart valve is narrow and slows down the normal blood flow.
  • Valve regurgitation—when blood leaks backwards because the valve does not close well.

Would you like to schedule an appointment with our Fetal Care Center?

4. There is fluid around your baby’s heart.

Also called “pericardial effusion,” this happens when fluid builds up around your developing baby’s heart.  This buildup of fluid may be caused by inflammation from a virus or autoimmune disease or may be a sign that your baby is in distress.

Sometimes, the fluid will go away on its own. Other times, medication, surgery or early delivery are necessary to help the baby.  It is important to return for your recommended appointments with your fetal cardiologist and fetal surgeon for problems with your baby’s heart. 

5. Your baby’s heartbeat is abnormal. 

Did you know that the smaller a person is, the faster the heart beats?  The normal fetal heart can often go as fast as 180 beats per minute.  An abnormal heartbeat, also known as an “arrhythmia,” means your baby’s heart is skipping beats, having extra beats, or beating faster or slower than normal.  

If your baby has an arrhythmia, your fetal cardiologist may recommend:

  • Close follow-up every one or two weeks, depending on the type of arrhythmia.
  • Medication to slow your baby’s heart down or put it back into a normal rhythm.
  • Early delivery if there are other signs the baby is in distress and there are no other options.

Although these conditions may not need treatment, some may need heart surgery after birth.  Others may even benefit from a procedure before birth using specialized fetal surgery by Dr. Crombleholme at the Fetal Care Center at Connecticut Children’s.  Connecticut Children’s is the #1 authority in fetal and pediatric heart surgery and we have a thoughtful team that works together to provide the best care for your developing baby.

With advances in medical treatment, a full life with a heart condition is no longer beyond imagination!