Heart Center

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Referral Indications for Fetal Echocardiograms: A Message From Dr. Bhawna Arya to Our Obstetric, Maternal Fetal Medicine and Fetal Cardiology Colleagues

Dr. Bhawna Arya

Dear Colleagues:

I wanted to share with you the hot-off-the-presses updated guidelines entitled “Guidelines and Recommendations for Performance of the Fetal Echocardiogram: An Update from the American Society of Echocardiography” published in the Journal of the American Society of Echocardiography last month. The co-authors are experts in the field, and our own fetal cardiologist Dr. Nelangi Pinto is one of the co-authors.

This new document replaces the 2004 guidelines and is focused on referral indications for fetal echocardiogram and has been updated from the previous American Heart Association (AHA) guidelines from 2014.

There are several important changes to share and a summary created by our Seattle Children’s Fetal Cardiology team is included here along with the original guidelines paper. The highlights are that a fetal echocardiogram is no longer indicated (based on low risk <3%) if the cardiac views are visualized and normal on obstetric anatomy scan and the following are present in isolation:


  1. In vitro fertilization
  2. Nuchal translucency (NT) less than 3.0 (between 3.0 and 3.5 MAY consider fetal echo)
  3. Maternal lithium or anticonvulsant exposure
  4. Obesity (BMI >30)
  5. Single umbilical artery (two-vessel cord)


Of course, if any concerns are raised by your team or the patient for any reason from a fetal cardiac perspective, the Seattle Children’s Fetal Cardiology team throughout the WAMI region (Washington, Alaska, Montana Idaho) is always more than happy to perform a fetal echo and consult with the patient. Our goal is to provide the best fetal cardiology diagnosis, care and counseling to families and make sure that as providers, your team has all of your questions regarding the fetal heart answered, no matter what the indication.

I am attaching the new guidelines paper (Table 1 includes all of the indications for fetal echo) as well as our Seattle Children’s concise summary of indications. Please reach out with any questions or concerns.


Bhawna Arya, MD

Associate Professor | Department of Pediatrics

Director | Prenatal Diagnosis Program

Director | Fetal Cardiology

Director | Advanced Imaging Fellowship | Division of Pediatric Cardiology

University of Washington School of Medicine

Seattle Children’s Hospital, Heart Center and Fetal Care and Treatment Center

206-987-3934  OFFICE

206-987-3839  FAX

[email protected]


Fetal Care and Treatment Center

Phone: 206-987-5629

Email: [email protected]


Refer a patient

Introducing the First Issue of Seattle Children’s Cardiac Beat

Our Heart Center is proud to introduce the inaugural edition of Seattle Children’s Cardiac Beat. In the first issue, you’ll find information about:

Seattle Children’s Cardiac Beat will publish news and information about the latest diagnostic, therapeutic and research advances in cardiovascular diseases and cardiac surgery at Seattle Children’s.



VADs and Video Games: How Hudson’s Heart Benefitted From the Latest Treatments and a Comprehensive Care Team

February is National Heart Month.

When a child’s heart is failing, Seattle Children’s Heart Center is equipped to deliver the latest lifesaving treatments from a caring team with the most experience and best outcomes in t

For Hudson, who has a rare form of muscular dystrophy that precipitously weakened his heart at age 9, the Heart Center’s cardiologists turned over every stone to treat his heart failure and buy time for him to get a new heart.

The latest treatments

Hudson’s care team used the latest ventricular assist device (VAD) technology to keep his heart going. Seattle Children’s is the only pediatric heart center in the Pacific Northwest with the depth of expertise to offer every type of therapy for heart failure, including VADs. We offer many types of VADs, including newer options not available at every hospital. Some patients will use more than one VAD.

Hudson first had an Impella VAD implanted when medication wasn’t working. It can be inserted with a small incision through an arm artery and can stabilize a patient before a bigger surgery. It’s a less invasive, less permanent option that in Hudson’s case was a stepping stone to a more durable, larger VAD. Read full post »

Heart Center “Goes All Out” in Its New, Larger Space

Seattle Children’s Heart Center has a new, state-of-the-art home in Forest B, the 310,000-square-foot addition to Seattle Children’s hospital campus specifically designed for transformative, patient-centered care.

Dr. Brian Morray, director of Seattle Children’s Cardiac Catheterization Laboratories, confers with a cardiac patient in one of Forest B’s new spaces.

The Heart Center occupies nearly 30,000 square feet on the sixth floor of the new building. The dedicated space doubles the number of operating rooms (ORs) devoted to cardiac patients and co-locates the cardiac induction rooms, ORs, catheterization labs, postanesthesia care unit (PACU) recovery rooms and cardiac intensive care unit (ICU) into what is known as the Heart Center Suites. Although the cardiac ICU is technically located in Forest A, it is separated from the ORs by a three-foot walkway.

This co-location of services greatly reduces patient transport time and facilitates those times when a patient needs to go quickly from the catheterization laboratory to surgery or from surgery to a catheterization lab. Read full post »