Fetal Cardiac Program

The Fetal Cardiac Program is a subsection of the Division of Cardiology in the Labatt Family Heart Centre at SickKids. Visit the Cardiology page to learn more about the other sections. 

The Fetal Cardiac Program is made up of a multidisciplinary team that provides detailed evaluation, counseling and treatment for heart problems in the developing baby during pregnancy. We work closely with family doctors, midwives, community and high-risk obstetricians throughout Ontario, as well as geneticists and other pediatric subspecialists. We partner with Mount Sinai Hospital to provide a range of fetal therapy through the Ontario Fetal Centre. The Fetal Cardiac Program is a teaching program in affiliation with the University of Toronto.

Heart problems in the developing baby may result from abnormal development of the heart (congenital heart disease), heart rhythm disturbances, complications from twin pregnancies, genetic conditions and health problems in the mother that affect the baby, including illness, medications and other exposures.

The goals of the Fetal Cardiac Program are to ensure that families receive the highest quality of care for potential heart problems during pregnancy; to advance our understanding of the evolution of heart disease in the developing baby; and to provide ongoing educational support to families and providers alike. We proudly serve as a local, national and international referral center for fetal cardiac care, research, and teaching.

When is a fetal echocardiogram performed?

As soon as a cardiac abnormality is suspected, we would recommend referral for fetal echocardiography regardless of the timing in the pregnancy.

If a cardiac abnormality is not suspected, there may still be reasons to perform a fetal echocardiogram, such as a heart rhythm disturbance, complication from twin pregnancy, genetic condition or health problem in the mother that affects the baby among others. A fetal echocardiogram performed at 18 to 20 weeks gestation is ideal for providing a thorough cardiac evaluation and allows for families to explore all options for the pregnancy if an abnormality is detected.

• Early fetal echocardiography may be performed at less than 16 weeks gestation for specific indications, such as a genetic condition or first-degree relative with severe congenital heart disease. Early fetal echocardiography and review/counseling are performed by a SickKids fetal cardiologist at our joint Early Anatomy Clinic with Mount Sinai Hospital. Depending on fetal position, transabdominal and/or transvaginal imaging may be used. At times important information may be obtained at this stage, while at other times the information can be limited. It is our practice to book a follow-up evaluation at 18 to 20 weeks for the majority of patients undergoing early fetal echocardiography.
• Third trimester fetal echocardiography can be difficult, but typically a majority of information can still be obtained and may be important for delivery planning.

Most referrals are scheduled within 1 – 2 weeks of initial referral; urgent referrals are seen within the same week. It is important to provide complete information for appropriate triage of referrals.

What happens during a visit?

After you register for your test, you will be asked a series of routine questions about your pregnancy and general health. This helps us ensure we are providing a complete evaluation of your baby’s heart.

A fetal echocardiogram, which is a type of ultrasound, is performed on your abdomen by a member of our team, either a sonographer or fellow who has been specifically trained to perform this evaluation. The test itself may take anywhere from 30 to 60 minutes and depends on how easily we are able to obtain clear images of the heart. Because we are examining the baby within the womb, the image quality is very dependent upon the position and activity of the baby. To improve the images, during this test you may be asked to empty your bladder, move from side-to-side or even take a brief walk. You may eat or drink before this test, and it is not necessary to have a full bladder. For these reasons, a longer test does not imply that there is a heart problem.

During the test, the sonographer or fellow will not give you the results. After your test is complete, the person performing your scan will review the images with one of the physician members of our team. The physician, who is a specially trained fetal cardiologist, may choose to obtain more images at this time. After all of the images are obtained, the doctor will review the results of the test with you and you will be given a copy of the results. A nurse is available to assist you in understanding your child’s condition and to plan your next steps. A follow-up evaluation may be arranged as needed.

As this may be a stressful time for you, we would recommend that your partner or another family member accompany you to this appointment. We would recommend against bringing small children to this appointment. Please review our latest visitor guidelines prior to your appointment.

What if there is a heart problem?

After the fetal echocardiogram, a doctor will speak with you and explain the results.

At times, imaging may be difficult. Although there may not be any abnormalities detected, the imaging may not be as complete as possible. In these cases, we may book a follow-up test to re-assess the heart; this does not mean that there is a heart problem.

If an abnormality is detected, a doctor and nurse will speak with you privately. During this time, we will provide you with as much detailed information about the heart problem as can be determined from the images. The effects of the heart problem on the pregnancy, birth and throughout the child’s life will be discussed. All options available for management of the pregnancy will be discussed. It may be necessary to refer you to a specialized obstetric program to ensure complete care is provided during the pregnancy and to ensure the best delivery plan is in place.

Normally, we will book additional appointments during the pregnancy to re-assess your baby's heart and to prepare you and your baby for delivery. Referral to other members of the team (social worker, nurse practitioner, lactation consultant, etc.) will be arranged to assist you in coping with and preparing for your journey.

Are there treatment options?

Certain fetal cardiac conditions can be treated and/or managed in utero, either with medications or minimally invasive interventions. In partnership with Mount Sinair and under the umbrella of the Ontario Fetal Centre, the Fetal Cardiac Program at SickKids is the first and only program in Canada offering fetal cardiac intervention.