Background: Fetal arrhythmias can disrupt coordinated myocardial contraction and, in severe cases, impair cardiac function. While conventional echocardiography assesses global systolic and diastolic performance, subtle segmental disturbances may go undetected. Fetal speckle-tracking echocardiography (STE) provides quantitative evaluation of ventricular mechanics and may offer added value in monitoring therapy response. Case Presentation: A 30-year-old pregnant woman at 27+3 weeks’ gestation was referred for suspected fetal arrhythmia. She had occupational exposure to various chemicals but no autoimmune antibodies. Fetal echocardiography revealed ventricular bradycardia (93 bpm) with atrial rate of 160 bpm, prolonged atrioventricular conduction with intermittent Wenckebach-type block, frequent atrial and ventricular ectopy, and cardiomegaly (CTAR 0.40). STE (FetalHQ) demonstrated global segmental left ventricular (LV) dysfunction and right ventricular (RV) impairment except in basal segments, despite no signs of hydrops. Maternal therapy with intravenous dexamethasone and oral salbutamol was initiated. Serial follow-up showed gradual normalization of ventricular rate, regression of cardiomegaly, and progressive recovery of segmental function, culminating in complete restoration of RV contractility and near-normal LV performance by 34+3 weeks. Conclusions: This case highlights the utility of fetal STE in detecting regional ventricular dysfunction and objectively documenting myocardial recovery in fetuses with mixed arrhythmias. Integration of advanced imaging into routine surveillance may improve assessment of treatment efficacy, guide management, and provide reassurance to both clinicians and parents when rhythm stabilization leads to functional recovery.

Prenatal diagnosis of coarctation of the aorta remains challenging due to reliance on indirect markers such as ventricular disproportion, which lack specificity and lead to high false-positive rates. Functional conditions, particularly redundant foramen ovale, may mimic coarctation through altered hemodynamics. Integration of morphological parameters improves diagnostic differentiation and supports more accurate prenatal risk stratification. Herein, we aim to share our insights into the prenatal diagnosis of coarctation of the aorta.

Background: Increased placental thickness has been associated with adverse perinatal outcomes and fetal functional and structural abnormalities. However, whether marked third-trimester placental thickening is associated with a distinct maternal clinical profile compared with pregnancies with normal placental thickness remains insufficiently characterized. This study aimed to compare maternal characteristics, comorbidities, medication exposure, infection history, and fetal findings between pregnancies with marked placental thickening, defined as placental thickness ≥70 mm, and gestational-age-matched control pregnancies with a placental thickness <70 mm and no documented maternal or fetal abnormalities. Methods: This retrospective matched case-control study included singleton pregnancies referred for fetal echocardiography to a tertiary referral center in Łódź, Poland, between 1 January 2022 and 14 March 2025. Placental thickness was measured sonographically in a perpendicular plane from the chorionic plate to the basal plate, excluding the umbilical cord insertion site. Only anterior and/or fundal placentas assessed at ≥28 weeks of gestation were included. Among pregnancies with recorded third-trimester placental thickness measurements, 99 cases with placental thickness ≥70 mm were identified as the thick-placenta group. A control group of 99 pregnancies with placental thickness <70 mm was selected and matched for gestational age. Control pregnancies had no documented maternal disease, no fetal structural or functional abnormalities, and no exposure to the medications analyzed in this study. Maternal demographic characteristics, body mass index, comorbidities, infection history, obstetric history, and medication use were compared between groups. Continuous variables were compared using Welch's t-test and the Mann-Whitney U test, and categorical variables were compared using Fisher's exact test. Results: The study included 99 pregnancies with marked placental thickening and 99 control pregnancies with normal placental thickness. Gestational age at examination was comparable between groups, with a mean of 35.5 weeks in controls and 35.0 weeks in the thick-placenta group (p = 0.662, Welch's t-test). Median gestational age was also not significantly different between groups (35.4 vs. 36.43 weeks; p = 0.340, Mann-Whitney U test). Mean placental thickness was significantly greater in the thick-placenta group than in controls (81.4 mm vs. 46.9 mm; p < 0.0001). Maternal age and anthropometric characteristics were comparable between groups, whereas BMI > 25 kg/m2 was more common in the thick-placenta group. In contrast to the clinically healthy control group, maternal infection was documented in 100.0% of thick-placenta cases, hormonal treatment in 97.0%, history of COVID-19 in 52.5%, hypothyroidism in 44.4%, prior miscarriage in 37.4%, aspirin or anticoagulant use in 32.3%, gestational diabetes mellitus in 25.3%, and pregnancy-induced hypertension in 7.1%. All evaluated maternal clinical factors were significantly more common in the thick-placenta group than in controls. Fetal cardiac or extracardiac dysfunction was present in 68.7% of thick-placenta pregnancies. Conclusions: In this gestational-age-matched case-control study, pregnancies with marked third-trimester placental thickening showed a distinct maternal profile compared with healthy controls with normal placental thickness. Despite comparable gestational age, maternal age, and maternal anthropometric characteristics, the thick-placenta group demonstrated a significantly higher infectious, hormonal, metabolic, and endocrine burden. These findings indicate that, in this selected tertiary referral cohort, placental thickness ≥70 mm was associated with a higher burden of maternal clinical abnormalities and fetal functional findings. Rather than representing an independent marker of placental maladaptation or maternal-fetal risk, marked placental thickening should be interpreted as a clinically relevant ultrasound finding that may prompt careful review of maternal history and targeted fetal assessment. Prospective studies are needed to determine which maternal factors are independently associated with placental thickening and to clarify their relationship with fetal function and perinatal outcomes.

OBJECTIVES:In majority of congenital heart defects the size of the fetal heart is normal (without cardiomegaly). Aim of this study was to establish normal ranges of fetal transversal cardiac diameter (4CV TW ED) and to compare fetal dextro-transposition of the great arteries (d-TGA) with normal ranges for 4CV TW ED. METHODS:Retrospectively of 3,553 records we analyzed and included 1,154 healthy singleton fetuses as a control group. Consecutive percentiles for 4CV TW ED diameter according to the gestational age (GA) were calculated. 74 fetuses with d-TGA were analyzed in 3rd trimester. RESULTS:The -2, -1, +1 and +2 Z-scores of 4CV TW ED between weeks 18 and 37 of gestation were calculated. In the group of fetuses with d-TGA 68 % of them had 4CV TW ED > +2 Z-score fitted for GA. Rashkind procedure during first 24 h after birth was performed in 63 % cases. Increased 4CV TW ED was more frequently seen in fetuses who needed Rashkind procedure after birth, but without statistical significance. CONCLUSIONS:4CV TW ED measurement during the third trimester scans as a cardiac screening tool in obstetrical practice may potentially help to detect d-TGA and indicate further echocardiographic examination in case of d-TGA suspicion. 4CV TW ED was not helpful to predict the necessity for neonatal Rashkind procedure.

Introduction: The relationship between diet of mothers, including supplementation of vitamin D and Long Chain Polyunsaturated Fatty Acids (LC-PUFA), and the prevalence of congenital heart defects (CHD) in the fetus has not been sufficiently studied. The aim of the study was to investigate the relationship between the intake of vitamin D and LC-PUFA by mother (from diet and with supplementation, including its time of implementation and applied dose), and the risk of CHD in the fetus. Methods: This was a case—control study with the participation of a total of 79 women with prenatally diagnosed CHD in the fetus and 121 women without CHD in the fetus. The Food Frequency Questionnaire (FFQ) was used with particular emphasis on vitamin D and DHA supplementation. A univariate logistic regression model was used to evaluate the relationship between selected dietary data and the risk of CHD in the fetus. Results: In the group of females without CHD in the fetus, the mean values of vitamin D intake, including supplementation, and dietary LC-PUFA + DHA from supplementation, were higher than in women with CHD in the fetus (41.3 ± 24.7 vs. 34.7 ± 27.8 μg; p = 0.02 and 831.0 ± 280.1 vs. 767.7 ± 287.6 mg; p = 0.008, for vitamin D and LC-PUFA + DHA respectively). No significant relationship was found between vitamin D intake (including supplementation) or between LC-PUFA + DHA supplementation by pregnant women, and the presence of CHD in their children. Conclusions: It seems that increased maternal intake of vitamin D and LC-PUFA, including DHA, through supplementation, may protect fetus against CHD, but the relationship between the occurrence of CHD and diet in this area need further studies.

Background/Objectives: The aim of this study was to determine the prevalence of functional cardiovascular anomalies detected on fetal echocardiography in third-trimester large-for-gestational-age (LGA) fetuses, who were subsequently born as macrosomic newborns with a birth weight exceeding 4000 g. Methods: A retrospective study was conducted on 1002 fetuses examined during the third trimester at our fetal cardiology center between 2018 and 2024. All fetuses were classified as having “normal heart anatomy” (NHA). Statistical analysis was performed using Microsoft Excel 2024, Statistica 13.1, and EasyMedStat (version 3.37.1). A p-value of <0.05 was considered statistically significant. Results: The 1002 fetuses were divided into two groups. The study group (NHA-LGA) consisted of 167 fetuses born with a weight of >4000 g and the control group (NHA-AGA) was made up of 835 fetuses with a birth weight between 2500 and 4000 g. In the NHA-LGA group, 24 fetuses (14.4%) experienced ductal constriction (DC), while in the NHA-AGA group, it was 11 (1.3%) fetuses (p < 0.00001). Myocardial hypertrophy was observed in 30 fetuses (18.0%) in the NHA-LGA group versus 72 (8.6%) in the NHA-AGA group (p < 0.0003). Additionally, cardiomegaly was noted in 95 fetuses (11.4%) in the NHA-LGA group, compared to 37 (4.4%) in the NHA-AGA group (p < 0.0004). Conclusions: LGA fetuses with normal heart anatomy may present with functional cardiovascular anomalies, including ductal constriction, myocardial hypertrophy, and cardiomegaly. In our cohort, such anomalies were identified in up to 51% of cases. These findings suggest that targeted fetal echocardiographic screening in macrosomic fetuses could be clinically valuable, even in the absence of structural heart defects, and may aid in the early identification of functional cardiac alterations that could impact perinatal management.

Total anomalous pulmonary venous connection is a rare congenital heart defect that can be diagnosed prenatally and might be very important for perinatal management. In addition to other cardiac abnormalities (levocardia, situs inversus, small left ventricle, double outlet right ventricle, parallel great vessels, and hypoplastic aortic arch), total anomalous pulmonary venous connection of a subdiaphragmatic type was diagnosed during a prenatal echocardiography examination in the second half of pregnancy. Fetal echocardiography monitoring showed no signs of congestive heart failure. The neonate was born at 38 weeks of gestation at our tertiary center. Postnatal echocardiography revealed significant progression in neonatal hemodynamics, and early cardiac surgery, involving repair of the pulmonary veins, pulmonary artery banding, and aortic arch reconstruction, was performed with a good outcome. This case is an excellent example of the value of prenatal echocardiography.

OBJECTIVES:In 2023 and 2024, our primary study group consisted of 39 fetuses with HLHS. MATERIAL AND METHODS:From the final analysis, we excluded the following: 1 twin pair (twin A with normal heart anatomy and twin B with HLHS), 2 terminations of pregnancy, and 2 newborns without prenatal echocardiography (only ultrasound was performed, and HLHS was not detected prenatally). As a result, our study group comprised 34 fetuses. The mean gestational age at the detection of HLHS was 19 weeks (± 6 weeks). Extracardiac malformations were present in 7 fetuses out of 34. Prenatally diagnosed genetic problems included Turner syndrome, DiGeorge syndrome, and an abnormal Y chromosome. RESULTS:Most pregnancies ended at term, with a mean gestational age at delivery of 38.5 weeks (± 0.9). The mean birth weight was 3142 g, and the mean Apgar score was 8 at 1 minute. After birth, there were 2 neonatal deaths: one newborn with HLHS and a birth weight of 1900 g, and another with HLHS and lymphangiectasies. Norwood surgery was performed in 32 newborns: in survivors, at a mean age of 12 ± 5 days, and in the non-survivor group, at a mean of 17 ± 5 days (t-test p = 0.027). The overall survival rate from 2023 to 2024 was 87% for liveborn fetuses/neonates, significantly higher than the historical data from 2008-2015, which showed a survival rate of 64% (chi-square p = 0.015). CONCLUSIONS:Prenatal echocardiographic data do not equate to cardiac surgery data, as they include deaths in utero, terminations of pregnancy, and deaths after delivery (presurgery mortality). In consultations with future parents following the prenatal detection of HLHS, the entire spectrum of possible outcomes should be discussed, including the survival rate after Norwood surgery at our center, which was approximately 90% from January 2023 to January 2025. The day of cardiac surgery may be an additional important risk factor.

Background/Objectives: The main goal of this study was to determine whether ductal constriction in the third trimester of a pregnancy during fetal echocardiography examination has an impact on the neonatal clinical condition during the first days after birth. Methods: A retrospective study was based on 348 newborns who were examined during their fetal life in the third trimester of a pregnancy in our fetal cardiology center. They were divided into two groups: the study group (n = 49): neonates with “normal heart anatomy” (NHA), assessed by fetal echocardiography (ECHO) examination and prenatally diagnosed ductal constriction (NHA-DC); and the control group (n = 299): NHA neonates without DC (NHA-NDC). Results: Prenatally, DC was associated with other functional abnormalities, such as myocardial hypertrophy, cardiomegaly, tricuspid regurgitation, pericardial effusion and abnormal flow through foramen ovale. Neonates with prenatally diagnosed DC in 43% of cases presented with elevated neonatal bilirubin levels requiring phototherapy treatment (p < 0.006). In the study group 27% of neonates showed signs of breathing difficulties in the first hours of life (p < 0.001). Neonates with a prenatal diagnosis of DC were hospitalized longer than neonates with a normal heart study (NHS) (p < 0.001). Conclusions: Neonates with a prenatal diagnosis of ductal constriction are prone to having transient respiratory problems (up to 27%) and mild neonatal hyperbilirubinemia (in presented series up to 43%). Gestational diabetes can be associated with ductal constriction.

Background: Placental thickness has been associated with adverse perinatal outcomes, but the relationship to specific fetal abnormalities seems to not yet be well understood. This study investigates whether increased placental thickness correlates with the severity of fetal cardiac and extracardiac conditions using a structured classification and severity-weighted scoring system. Methods: We undertook a retrospective analysis of 1452 fetal echocardiograms conducted during the third trimester at a tertiary referral institution from the years 2022 to 2025. The diagnoses were categorized into four distinct classifications: congenital heart anomalies, cardiac dysfunctions, extracardiac malformations, and extracardiac dysfunctions. Each diagnostic category was allocated a severity weight predicated on established fetal and neonatal mortality risk literature. The evaluation of placental thickness was regarded not merely as a persistent variable but also categorized into three distinct classifications: thin (≤40 mm), intermediate (41–69 mm), and thick (≥70 mm). The examination of correlations was performed utilizing Spearman’s ρ; comparative evaluations among the groups were conducted employing the Kruskal–Wallis and Mann–Whitney U tests. Results: Placental thickness revealed a moderate positive correlation with weighted extracardiac dysfunctions (ρ = 0.36, p < 0.00001), displayed a comparatively weaker yet statistically significant association with cardiac dysfunctions (ρ = 0.13, p = 0.01). Fetuses identified by increased placental thickness (≥70 mm) exhibited notably higher mean scores for both cardiac and extracardiac dysfunctions. Within the cohort exhibiting thick placentas, 25.8% displayed extracardiac dysfunction scores surpassing 0.3, in contrast to only 7.7% within the cohort with thinner placentas. Conclusions: Augmented placental thickness correlates with an elevated cumulative load of fetal dysfunction, especially in the realms of extracardiac and functional cardiac impairments. The measurement of placental thickness may function as a straightforward, supplementary indicator of fetal distress in the third trimester, particularly when utilized alongside targeted imaging modalities.

Background: Pulmonary hypertension (PH) in newborns is a rare but serious condition and potentially life-threatening disorder, often initially confused with congenital heart disease due to overlapping echocardiographic findings in the late third trimester. Evidence on prenatal predictors of postnatal PH is limited. We aimed to describe detailed third-trimester echocardiographic findings associated with postnatal PH in infants with prenatally suspected CoA based on a retrospective case series. Methods: We reviewed 18 years of fetal echocardiography (2004–2022) in a tertiary maternal–fetal–neonatal center. We identified fetuses with suspected coarctation of the aorta (CoA) in late gestation who were delivered at term (≥37 weeks) and had prolonged neonatal hospitalization (>10 days) without cardiac surgery or catheterization. Z-scores for cardiac dimensions were calculated. All examinations were performed by experienced fetal cardiologists. Postnatal evaluations confirmed PH based on echocardiographic and clinical findings. Results: Among 19,836 fetuses examined, 138 were prenatally suspected of CoA. In 70 cases, this diagnosis was not confirmed postnatally (false positives). Of these, eight infants (0.04% of the total cohort) developed postnatal PH. Postnatally, all eight neonates required intensive care. Prenatal features included ventricular/atrial disproportion (7/8), cardiomegaly (8/8), main pulmonary artery dilatation (10.2 ± 2.2 mm; Z-score +2.7 ± 1.3), tricuspid regurgitation (8/8), pulmonary regurgitation (4/8), and interventricular septal hypertrophy (>4.5 mm in 5/8). Postnatal evaluations confirmed PH based on echocardiographic criteria (elevated right ventricular pressure, septal flattening/bowing, right ventricular dilation or dysfunction, and abnormal shunt direction) combined with clinical compromise. All infants received prostaglandin E1 (PGE1) initially; none required extracorporeal membrane oxygenation-ECMO. Three died, while five survived with medical management (oxygen, inhaled nitric oxide, sildenafil). Conclusions: Specific functional abnormalities on late third-trimester echocardiography may indicate impaired pulmonary vascular adaptation and predict postnatal PH, particularly in cases initially suspected of CoA. Recognition and awareness of these findings can guide delivery planning, neonatal surveillance, and timely intervention. Prospective multicenter studies are needed to validate these associations and refine prenatal screening protocols.

Aim:Hypoplastic left heart syndrome is a severe congenital heart defect that may be accompanied by tricuspid and mitral valve regurgitation. The aim of this paper is to identify a new ultrasound marker for evaluating the outcomes of fetuses with hypoplastic left heart syndrome. Material and methods:This was a single-center analysis of a group of fetuses who underwent fetal ultrasound examinations at our tertiary center between 2016 and 2023. This study included 80 fetuses with hypoplastic left heart syndrome. The gestational age of the studied fetuses ranged from 16.3 to 39.5 weeks. All anomalies and irregularities accompanying hypoplastic left heart syndrome were detected during the second and third trimesters of pregnancy. Results:Among fetuses with hypoplastic left heart syndrome with tricuspid regurgitation, the mortality rate was 0% (0/16) and the survival rate was 100% (16/16). In contrast, in fetuses with hypoplastic left heart syndrome with both tricuspid and mitral regurgitation, the mortality rate was 75% (3/4) and the survival rate was 25% (1/4). The incidence of death was significantly higher in the group of fetuses with hypoplastic left heart syndrome with both tricuspid and mitral regurgitation compared to the group with tricuspid regurgitation (Yates's chi-squared test: p = 0.003; Fisher's test: p = 0.0035). Conclusions:The coexistence of hypoplastic left heart syndrome with tricuspid and mitral regurgitation is significantly associated with the death of newborns even when treatment and/or surgery is performed. Therefore, the presence of mitral regurgitation in fetuses with hypoplastic left heart syndrome may serve as an additional ultrasound marker for poor neonatal outcome.

Background and Clinical Significance: This article explores the application of fetal speckle tracking technology in evaluating critical aortic stenosis (AS) in fetuses, highlighting its potential for predicting neonatal outcomes. Case Presentation: We present two cases of fetuses diagnosed with critical AS and associated complications at late gestation. Case 1 demonstrated preserved left ventricular function, as indicated by favorable global strain (GS), fractional area change (FAC), and ejection fraction (EF) values, despite critical conditions. This infant underwent successful postnatal interventions and was discharged after an extended NICU stay. In contrast, Case 2 exhibited severely compromised left ventricular function with significantly reduced GS, FAC, and EF parameters, leading to a tragic outcome despite intensive management. Conclusions: Our findings suggest that innovative echocardiographic parameters such as GS, FAC, and EF for the left ventricle are crucial in prognostic evaluations for fetuses with critical AS. The study underscores the importance of advancements in fetal cardiology and the need for further research to enhance prognostic assessments and improve clinical outcomes in affected neonates.

The echocardiographic monitoring of a fetus with multiple nuchal cords around the fetal neck is important as it may result in cardiac remodeling and preferential streaming, thus affecting the condition of the fetus. The main aim of our study was to assess whether the collision of the umbilical cord around the fetal neck can lead to discrepancies in the size of the pulmonary artery and the aorta in the three-vessel view and to an increase in the size of the heart, which may result from the compression of the carotid arteries caused by the umbilical cord wrapping around the fetal neck. A total number of 854 patients were included in this study and divided into three groups. Group A (control group) included 716 fetuses (84%) without the umbilical cord around the fetal neck. Group B (study group B) included 102 fetuses (12%) with one coil of the umbilical cord around the fetal neck. Group C (study group C) included 32 fetuses (4%) with two coils of the umbilical cord around the fetal neck. The range of the gestational age of the patients considered for this study was 27–40.2 weeks based on the ultrasound biometry and was not statistically different between the analyzed groups A, B and C (p > 0.05). The Pa/Ao index was calculated by dividing the value of the width of the pulmonary artery (in mm) to the width of the aorta (in mm) measured in the ultrasound three-vessel view. We found that fetuses that the fetuses with one and two coils of the umbilical cord around the neck showed significantly higher values of the width of the pulmonary trunk with the unchanged value of the aorta width. Therefore, we also observed significantly higher values of the ratio of the pulmonary trunk to the aorta for the fetuses wrapped with the umbilical cord around the neck compared with the control group without the umbilical cord around the neck (. Moreover, in the fetuses with one and two coils of the umbilical cord around the fetal neck, an increased amount of amniotic fluid was observed, whereas larger dimensions of CTAR in the fetuses with two coils of the umbilical cord around the neck were present (p < 0.05). The wrapping of the fetus with the umbilical cord around the fetal neck may induce the redistribution of blood flow, leading to fetal heart enlargement and disproportion and may be the cause of polyhydramnios.

Background/Objectives: Better understanding of and addressing umbilical entanglement in the third trimester of pregnancy is necessary to estimate its impact on fetal circulation. An analysis of single physiological pregnancies wrapped with one or two coils of the umbilical cord around the neck makes it possible to understand the severity of the problem and distinguish it from perinatal umbilical strangulation. Methods: In an echocardiographic study performed at 32.1 weeks of pregnancy in fetuses with one and two coils of the umbilical cord around the neck, the pulsatility index (PI) and the Tei index for the left (Tei LV) and right ventricle (Tei RV) of the heart were measured to evaluate cardiac function. Results: The study showed significantly higher Tei RV and Tei LV for fetuses with one (93 cases) and two coils of the umbilical cord around the fetal neck (26 cases) with respect to the control group of fetuses (680 cases) with no umbilical cord around the fetal neck, whereas PI UMBA did not differ significantly. Conclusions: Wrapping of the umbilical cord around the fetal neck may affect the study of the fetal heart without any mechanically induced compression of the umbilical vessels in normal pregnancy.

Background: The available data on the relationship between diet/folic acid and congenital heart disease (CHD) are not consistent. This study aimed to investigate the relationship between the intake and supplementation of folic acid and other selected factors in mothers and the risk of congenital heart defects in fetuses. Methods: A case–control study was conducted. The study group included pregnant women with fetuses from singleton pregnancies with prenatally diagnosed heart defects in the fetus (n = 79) and pregnant women whose course of pregnancy was normal with no heart defects or other developmental anomalies diagnosed in the fetus (n = 121). The patients were diagnosed at a reference center in Poland. The women completed a lifestyle questionnaire and FFQ and precisely described their use of dietary supplements. A univariate logistic regression model was used to evaluate the association between folic acid and selected risk factors and CHD. The association was significant and included such risk factors such as nutritional status, medications taken, smoking, and alcohol consumption. Additionally, the time of starting folic acid supplementation turned out to be statistically significant. The reference period of supplementation was the period before pregnancy. Results: Lack of supplementation increases the risk of heart defects in children by more than four times compared to supplementation before pregnancy (OR = 4.19; p = 0.0117), whereas supplementation beyond the eighth week of gestation increases the risk almost threefold (OR = 2.90; p = 0.0474). The presence of congenital defects in the family is also an important factor. Conclusions: A history of congenital heart defects or other defects, lack of periconceptional folic acid supplementation, and lack of dietary supplementation before pregnancy were associated with congenital heart defects in the fetus. Place of residence, parents’ education, lifestyle habits such as smoking and alcohol consumption, nutritional status before pregnancy, and mother’s diseases did not show a significant relationship with congenital heart defects in the children. There is an urgent need to develop preventive strategies and conduct extensive public education.