ARTICLE IN PRESSGUIDELINES AND STANDARDSGuidelines and Recommendations forPerformance of the Fetal Echocardiogram:An Update from the American Society ofEchocardiographyAnita J.Moon-Grady,MD (Co-Chair),Mary T.Donofrio,MD (Co-Chair),Sarah Gelehrter,MD,Lisa Hornberger,MD,Joe Kreeger,ACS,RCCS,RDCS,Wesley Lee,MD,Erik Michelfelder,MD,Shaine A.Morris,MD,Shabnam Peyvandi,MD,Nelangi M.Pinto,MD,Jay Pruetz,MD,Neeta Sethi,MD,John Simpson,MD,Shubhika Srivastava,MD,and Zhiyun Tian,MD,San Francisco and Los Angeles,California;Washington,District of Columbia;Ann Arbor,Michigan;Edmonton,Alberta,Canada;Atlanta,Georgia;Houston,Texas Salt Lake City,Utab;Durham,North Carolina;London,United Kingdom;Wilmington,Delaware;andPhiladelphia,PennsylyaniaKeywords:Prenatal diagnosis,Congenital heart disease,Fetal arrhythmia,Hydrops,CardiomyopathyThis document is endorsed by the Fetal Heart Society,the Society of Pediatric Echocardiography,and theAmerican Institute of Ultrasound in Medicine.TABLE OF CONTENTSA.Rhythm Disturbances and Tools for Assessment 16L.Introduction2B.Assessment of Fetal Cardiac Functional Abnommalities 18II.Indications2i.Imaging Tools for Assessing Fetal Cardiac Function 18Ill.The Fetal Echocardiographic Examination4ii.Specific Types of Cardiovascular Perturbation in the Fetus19A.Timing of Examination,Equipment,and Image Storage 5iii.Additional Imaging:Extracardiac Doppler and Adjunct/AdvancedB.Safety 8Techniques20C.Examination Technique 9C.Structural Heart Disease 21D.Image Optimization 9i Single Ventricles and Assessment for Ductal Dependence 21E.Standard Views and Imaging Planes 11ii.Complex AV Connections 24F.Cardiac Biometry and Measurement Data 14iii."Look-Alike"Outflow Tract Lesions 26G.Doppler Ultrasonography 14iv.Progressive Lesions,Obstructive and Regurgitant 30H.Complete Fetal Cardiac Assessment Using Segmental Analysis 16v.Isolated Arch Abnormalities 40I.Alternative Ultrasound Modalities 16D.Imaging-Based Risk Assessment and Delivery Planning for the Preg-I.Fetal Echocardiography in Early Gestation (<15 Weeks)16nancy Affected by Fetal Heart Disease 41IV.Guidance for Disease-Specific Anatomic,Physiologic,and FunctionalV.Summary and Conclusions 42Fetal Echocardiographic Evaluation 16From the University of Califomia,San Francisco,San Francisco,CalifomiaPeyvandi,MD,FASE,Nelangi M.Pinto,MD,FASE,Neeta Sethi,MD,Shubhika Sri-(A.J.M.-G.,S.P.):Children's National Hospital,Washington,District of Columbiavastava,MD,FASE,and Zhiyun Tian,MD.(M.T.D.):the University of Michigan,Ann Arbor,Michigan (S.G.);the University ofThe following authors reported relationships with one or more commercial inter-Alberta,Edmonton,Alberta,Canada (LH.):Children's Healthcare of Atlantaests:Wesley Lee,MD,has received limited research support from GE Healthcare.Atlanta,Georgia (J.K.);Baylor College of Medicine,Houston,Texas (W.LJay Pruetz,MD,has been a consultant for Prolacta Bioscience.John Simpson,S.A.M.);Emory University/Children's Healthcare of Atlanta,Atlanta,GeorgiaMD,has been
