Assessing fetal cardiac ventricular function.

Fetal echocardiography has been used primarily to identify fetuses with structural malformations of the heart. Evaluation of fetal ventricular function, however, has received minimal attention since the inception of fetal echocardiography in the early 1980s. This communication reviews the use of M-mode, B-mode and pulsed Doppler ultrasound to examine cardiac function. M-mode ultrasound is used to determine the size of the fetal heart, the end-diastolic and end-systolic dimensions of the ventricular chambers, and the thickness of the ventricular walls and the interventricular septum, and to measure the diameter of the mitral and tricuspid valves as well as the diameter of the aorta and pulmonary artery. B-mode evaluation of the fetal heart includes measurement of atrial and ventricular dimensions as well as dimensions of the outflow tracts. This modality is useful when M-mode measurements cannot be made due to fetal position. Once measurements of cardiac structures are obtained using either M-mode or B-mode ultrasound, pulsed Doppler recording of mitral valve, tricuspid valve, aortic valve and pulmonary artery waveforms can be used to compute cardiac output as well as stroke volume. In addition, pulsed Doppler can be used to evaluate diastolic and systolic cardiac functions by examining the components of each waveform.