Advancements in prenatal diagnosis and management of hypoplastic left heart syndrome: A multidisciplinary approach and future directions

Table 1 Indications for fetal echocardiography

Indications for fetal echocardiography	Indicated	May be considered	Not indicated
Maternal factors (absolute risk)
Pre-gestational diabetes	Yes	-	-
Gestational diabetes diagnosed in first or early second trimester	-	Yes	-
Gestational diabetes diagnosed after second trimester	-	-	Yes
Phenylketonuria (phenylalanine level > 10 mg/dL)	Yes	-	-
Autoimmune disease: SSA/SSB positive	Yes	-	-
In vitro fertilization	-	Yes	-
Confirmed fetal infection (TORCH- and parvovirus-B19-positive)	Yes	-	-
First- or second-degree relative with disease of Mendelian inheritance and history of childhood cardiac manifestations	Yes	-	-
Family history of CHD: First-degree relative	Yes	-	-
Family history of CHD: Second-degree or more distant relative	-	-	Yes
Obesity (BMI > 30 kg/m2)	-	-	Yes
Retinoids	Yes	-	-
ACE inhibitors	-	Yes	-
Paroxetine	-	Yes	-
Other selective serotonin reuptake inhibitors	-	-	Yes
Anticonvulsants	-	-	Yes
Alcohol	-	-	Yes
Lithium	-	-	Yes
Warfarin	-	-	Yes
Fetal factors identified during screening (absolute risk)
Suspected cardiac structural anomaly	Yes	-	-
Fetal hydrops	Yes	-	-
Extracardiac anomaly known to be associated with CHD	Yes	-	-
Persistent fetal tachycardia (heart rate ≥ 180 bpm)	Yes	-	-
Suspected heart block or persistent fetal bradycardia (heart rate ≤ 110 bpm)	Yes	-	-
Frequent episodes or persistently irregular cardiac rhythm	Yes	-	-
Suspected abnormality of cardiac function or cardiomegaly	Yes	-	-
Chromosomal abnormalities	Yes	-	-
Monochorionic twinning	Yes	-	-
Nuchal translucency 3.0-3.4 mm		Yes	-
Nuchal translucency ≥ 3.5 mm	Yes	-	-
Single umbilical artery in isolation	-	-	Yes
Other considerations
Non-cardiac “soft marker” for aneuploidy	-	-	Yes
Abnormal serum analytes (e.g. α-fetoprotein level)	-	-	Yes
Echogenic intracardiac focus	-	-	Yes
Prenatal fever or viral infection with seroconversion only	-	-	Yes

SSA/SSB: Anti-Ro/SSA and anti-La/SSB antibodies; TORCH: Toxoplasma gondii, Rubella virus, Cytomegalovirus, and Herpes simplex virus; CHD: Congenital heart diseases; Congenital heart diseases; BMI: Body mass index; ACE: Angiotensin converting enzyme.