Introduction

Sonographers must appreciate the indications for a full fetal echocardiogram. In 1997 the American College of Cardiology (ACC) and American Heart Association (AHA) in collaboration with the American Society of Echocardiography presented recommendations and an executive summary concerning the performance of fetal echocardiography.1 Table 1 lists the accepted indications for referral of a patient for a fetal echocardiogram. Table 2 lists possible indications for a fetal echocardiogram. Table 3 lists patients who should not be referred for a fetal echocardiogram. Expanding on the ACC/AHA guidelines, Tables 4,5, and 6 list commonly accepted fetal, maternal, and familial indications for a fetal echocardiogram. Tables 7 to 13 provide further data on these indications, listing specific diagnosis, risks, malformations, types of congenital heart disease, genetic syndromes, and selected medications affecting the fetal heart. Four-chamber screening for congenital heart disease should only be performed in fetuses with no indication for a full fetal echocardiogram. Conversely, four-chamber screening should be carried out anytime a complete routine fetal sonogram is performed when no indications for a fetal echocardiogram exist.