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Pediatric & Fetal Echocardiography

According to the University of Pennsylvania’s School of Medicine, every day in the United States approximately 100 babies are born already having heart defects. The Children’s Hospital of Philadelphia adds that problems with the heart are the most common birth defect detected.

baby with doctor

Fortunately, in addition to routine ultrasounds, echocardiograms (ultrasounds of the heart) may be performed on fetuses between the 18th and 24th week of pregnancy to detect cardiac problems early on. Generally fetal echocardiography is carried out if the family’s medical history reflects heart disease/defects or if an abnormal heart beat is detected during a routine sonogram. Some defects can be treated before the baby is born (i.e. fetal arrhythmias); for other problems, a healthcare team comes up with a plan to prepare for a safe delivery and for treatment/interventions to commence immediately after the baby is born.

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For children born with heart defects (congenital) or who develop conditions after birth (acquired), there is also pediatric echocardiography. Examples of congenital heart defects include ASD (atrial septal defect, which could lead to too much blood flow to the lungs), pulmonary atresia (which could lead to too little blood flow to the lungs) and AS (aortic stenosis, which could lead to not enough blood flow to the rest of the body). Some acquired heart defects include rheumatic fever (which could damage the heart valves) and IE (infective endocarditis, which could cause congestive heart failure).

Echocardiograms (also referred to as an “Echo”) performed on pediatric patients are not only useful to detect and diagnose heart defects; they also may be useful during treatment, such as surgery.


The American Registry for Diagnostic Medical Sonography (ARDMS) certifies sonographers/ultrasound technicians with credentials that are recognized globally. While not all states require certification, most healthcare employers will only consider candidates who are credentialed. The ARDMS offers both Fetal Echocardiography (FE) and Pediatric Echocardiography (PE) examinations. Upon successful completion of the FE exam, individuals can either earn the RDMS (Registered Diagnostic Medical Sonographer) or RDCS (Registered Diagnostic Cardiac Sonographer) credential.

Those who pass the PE exam, earn the RDCS credential. (To earn the RDCS credential, individuals must also complete the SPI – Sonography Principles & Instrumentation – examination). The ARDMS has several educational and experiential prerequisites (i.e. an ultrasound degree) for eligibility to sit for one of its exams.  In April 2014, the American Registry for Diagnostic Medical Sonography (ARDMS) announced that in February 2015 it will administer its very first Pediatric Sonography specialty exam.

Procedures and Instrumentation

Fetal echocardiography is performed while a fetus is still developing in his or her mother’s womb. It may be performed either as an abdominal or transvaginal ultrasound. For the former, a transducer or probe is placed overtop the mother’s abdomen. The transducer sends sound waves to the fetus’ heart; the echoes reflected back are transformed into images which show up on the ultrasound machine’s monitor. As part of a transvaginal ultrasound, the probe is inserted into the vagina. A transvaginal ultrasound usually generates clearer images compared to abdominal sonography.

May 9, 2012 — The U.S. Food and Drug Administration (FDA) has raised the ante in its drive to reduce pediatric radiation dose, launching a new program that will require manufacturers to consider the safety of children when designing new x-ray imaging devices.

Eric Barnes,Brian Casey, staff writers

The FDA has made the distinction that ultrasound equipment releases no ionizing radiation.

For pediatric echocardiograms, the sonographer places the transducer on top of the patient’s chest region so that sound waves can bounce off the infant or child’s heart. Often times an electrocardiogram (EKG) is performed at the same time as an echocardiogram. An EKG is used to assess heart beat, rhythm and electrical activity. Electrodes (sticky pads) are placed on the patient for the EKG.

Patient Care

stuffed animalSonographers specialized in pediatric and/or fetal echocardiography must not only be skilled technically and medically but must also practice compassion and care. Expecting parents whose fetuses are being examined for potential heart defects may be overcome by fear. Pediatric patients (infants and children) going in for an echocardiogram, along with their parents, may also feel a tremendous amount of angst. Ultrasound technicians should make it a priority to do what they can to make their patients feel as comfortable as possible while explaining the procedures in an accessible manner.

Learn more about a career in pediatric echocardiography by reading our interview with Chelsey Wright, BS-MIRS, RDCS (AE, PE), RDMS.

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