Congenital ventricular diverticulum (VD) and aneurysm are rare cardiac developmental anomalies and their pathophysiology is still unclear. They present as an anomaly of the four chambers view, cardiomegaly, arrhythmia, pericardial effusion, or hydrops. They are usually isolated anomalies. Differential diagnosis between diverticulum and aneurysm is challenging during the prenatal period. Management policy is not uniform either conservative or repeated pericardial puncture. Objective We wanted to describe prenatal features and post‐natal outcomes of fetal cardiac out pouching. Methods We retrospectively report 6 cases of VD and aneurysm prenatally managed in our fetal medicine unit between 2010 and 2020. All cases were evaluated from the first or second trimester of pregnancy until postnatal follow‐up (3 months to 3 years). Results All six cases underwent a monthly ultrasound follow‐up with spontaneous regression of pericardial effusion, and normal hemodynamics at birth No pericardial puncture was done and postnatal outcome was favorable in all cases. Conclusion Based on our experience and on cases previously published, prenatal counseling should be prudent regarding the final diagnosis. Referral and monthly prenatal ultrasound follow‐up, birth in a tertiary center after multidisciplinary evaluation and cardiological evaluation at birth still seem mandatory.

Brief summary The long-term prospective multi-centre nationwide (French) observational study FRANCISCO will provide new information on perimembranous ventricular septal defect with left ventricular overload but no pulmonary hypertension in children older than 1 year. Outcomes will be compared according to treatment strategy (watchful waiting, surgical closure, or percutaneous closure) and anatomic features of the defect. The results are expected to provide additional guidance about the optimal treatment of this specific population, which is unclear at present.

i FOREWORDWhen Drs Rizzo and Arduini asked me to write this preface, I was honored and thrilled to have the opportunity to introduce this outstanding work! Examining the fetal heart has always presented a huge challenge for ultrasound specialists. When I started in ultrasound 30 years ago, no one knew how to perform or even attempt the examination of the heart. Fetal echocardiography has progressed very rapidly, fueled by advances in image quality as well as increasing focus of the ultrasound community on the need for a proper examination of the heart. Even today, the detection of congenital heart defects remains at the very bottom of the list of identifiable abnormalities on a standard fetal sonogram, and well under 50% of congenital heart defects are identified by prenatally. Detection of congenital heart disease has lagged behind the successful detection of other abnormalities of the fetus despite our best attempts to teach the necessary skills. The fetal heart is a difficult organ to evaluate due its very small size, complex anatomy, dynamic blood flow physiology, as well as rapid rhythmical movement.

Congenital heart defects (CHD) are among the most common birth defects, occurring in 5 to 10 per 1000 live births. This substantial variation in the reported epidemiology of CHD is due to differences in applied methodologies. An increasing total prevalence of CHD has been recently reported, mainly due to increase in prevalence of small defects easily diagnosed by echocardiography, as well as an increase in prevalence of conotruncal defects and atrioventricular septal defects.In order to provide a comprehensive epidemiological overview, future studies should use international classification system as well as consistent inclusion and exclusion criteria. Futher studies are also required to evaluate precisely the impact of fetal cardiac diagnosis on the prevalence and outcome of CHD. Epidemiology of CHD provides an overview of the distribution and characteristics of risk factors. Environmental potential risk factors are reviewed as they may provide an opportunity for prevention of some forms of CHD.