The main function of the heart is to provide an adequate perfusion to the
different organs. This function is achieved through an adequate filling of the ventricles
from the atria (diastole) and the subsequent contraction of the muscular walls in order
to generate a sufficient pressure to eject blood from the ventricles into the aorta and
pulmonary artery (systole). The inability of the heart to provide sufficient perfusion the
body tissues is defined as “heart failure”. In the fetus, heart failure is usually a late
event characterized by cardiomegaly, atrioventricular regurgitation and fetal hydrops
that occur after a subclinical period of cardiac dysfunction when the heart tries to adapt
to the initial stages of an insult through cardiac remodelling. Different cardiac and
extra-cardiac conditions can lead to fetal cardiac dysfunction and cardiac failure in
utero. Intrinsic cardiac conditions potentially leading to heart failures include
cardiomyopathies, structural abnormalities and persistent arrhythmias, while extrinsic
causes comprise extra-cardiac lesions that contribute to heart failure through high
output states, increased afterload, or cardiac compression resulting in low cardiac
output and increased central venous pressures. The aim of this chapter is to provide an
up-to-date on the causes, physiopathology, prenatal diagnosis and clinical implications
of the most common extra-cardiac conditions potentially leading to fetal heart
dysfunction.
Keywords: Congenital anomalies, Diagnosis/methods, Echocardiography, Fetus, Heart failure, Treatment outcome.
