Objective To determine the referral pattern for fetal echocardiography (FE) at our tertiary referral center for pediatric cardiac care in northern India. We also aimed to determine the incidence of CHD in each group and intend to highlight the need of identifying the various risk factors and appropriate timely referral of patients for detailed evaluation. Methods This is a prospective study including 201 consecutive patients referred for fetal echo to our center. Data collected included referral indication, gestational age, maternal age, the gravida, and the final diagnosis after detailed fetal echo. Various indications that were evaluated included maternal diabetes (pre-gestational or gestational), echogenic cardiac nodule, abnormal four chamber on ultrasound, other extra-cardiac abnormalities detected on ultrasound, and twin pregnancies or IVF conceptions. Some women had opted for fetal echo electively and they were defined as self referral. Results The mean gestational age of referral was 24 ± 5 weeks. Out of these, 196 had specific referral 123 indication while five were self referrals. The most common indication for referral was echogenic cardiac foci. CHD was diagnosed in 38 (19 %) patients. Indication that yielded the highest number of CHD cases was cardiac abnormality on USG. The mean gestational age at referral in those detected to have CHD was 27 ± 4 weeks. The commonest CHD detected was tiny VSD, while most of the complex CHD's were diagnosed in those referred for cardiac abnormality on USG.Conclusion CHD detection is highest in those referred for abnormal cardiac imaging on USG, and hence a careful assessment of fetal heart during routine prenatal screening would increase the CHD detection markedly. Nuchal translucency needs to be measured accurately and those with value greater that 99th centile should be referred for FE. Mothers with pre-gestational diabetes should have a FE prior to 20 weeks to rule out CHD. A FE scan in third trimester is indicated in diabetic females (gestational and pre-gestational) if the glycemic control is poor evidenced by HbA1c [ 6 %. Timely referral is absolutely essential so that appropriate counseling of the parents can be done.

Objective:The aim of this study was to determine normal values for fetal left ventricular (LV)-myocardial performance index (MPI) in Indian population and to assess its relation to advancing gestation and fetal heart rate (FHR).Materials and Methods:Two hundred pregnant women without any pregnancy-related complications and whose fetuses were shown to have structurally normal hearts were enrolled in this study. Doppler waveform involving simultaneous display of mitral inflow and LV outflow was obtained in all. Various intervals including isovolumetric contraction time (IVCT), isovolumetric relaxation time (IVRT), and ejection time (ET) were measured and then the MPI was calculated using the formula IVCT + IVRT/ET. Also the correlation between MPI and gestation age and FHR was assessed. We also reviewed the literature on the use of MPI for the assessment of fetal LV function.Results:The normal MPI in second and third trimester fetuses of Indian population was 0.42 ± 0.03. The mean IVCT was 33 ± 4 milliseconds (ms), mean IVRT was 39 ± 5 ms, and mean ET was 169 ± 9 ms. The mean heart rate was 148 ± 8 bpm and the mean PR interval was 111 ± 10 ms. There was no significant association of LV-MPI with either FHR or advancing gestation.Conclusion:MPI is a useful parameter for the assessment global cardiac function. MPI has the advantage of not being affected by FHR, ventricular size, and geometry or image quality. The review of literature shows its significant importance in monitoring complicated pregnancies.

Absent pulmonary valve syndrome is a rare anomaly and its combination with a complete atrioventricular septal defect and double-outlet right ventricle is even rarer which has never been reported in the literature as an antenatal diagnosis. We report a case of a 21-week fetus diagnosed having this rare combination of lesions. The main purpose of reporting this case is to highlight the prognostic implications for the fetus with this complex heart defect. There is a high risk of fetal heart failure and a higher risk of associated extracardiac and chromosomal anomalies. Unfortunately, the pregnancy was terminated, and hence, further antenatal course and postnatal details could not be evaluated.

The Fontan connection, originally described in 1971, is used to provide palliation for patients with many forms of CHDs that cannot support a biventricular circulation. An increasing number of females who have undergone these connections in childhood are now surviving into adulthood and some are becoming pregnant. We report a case of a 29-year-old woman who presented with a twin pregnancy at 33 weeks of gestation. She had significant deterioration of her cardiovascular status before the twin babies were delivered by emergency caesarean section owing to associated obstetric complications. This report also highlights the various maternal and fetal complications occurring in pregnancy of Fontan-palliated patients and suggests the need for meticulous pre-conception counselling and strict perinatal care.

A supramitral ring is a rare cause of mitral stenosis, while an isolated mitral valve cleft is a rare cause of congenital mitral regurgitation. Fortunately, both the lesions are known to have good outcomes after surgical correction. Although each is known to be associated with a variety of other structural heart defects, their coexistence has not been reported previously. We report a case of a three- and half-year-old boy detected to have a rare combination of supramitral ring producing severe mitral stenosis with a coexisting cleft in the anterior leaflet of mitral valve causing severe mitral regurgitation. The patient underwent successful surgical repair with resolution of both mitral stenosis and regurgitation.