Three different types of pediatric echocardiography are available to patients and their families: fetal, transesophageal and transthoracic. The most appropriate approach depends on the patient and the situation. When a doctor recommends a pediatric echocardiogram, often to learn more about congenital heart disease, he or she might discuss the options available and provide information about benefits and drawbacks. If there is a choice available, the patient and family can discuss the decision and request a specific type.
For any kind of prenatal examination of the heart, a fetal echocardiogram is necessary. In this approach to pediatric echocardiography, the doctor views the baby's heart inside the womb, using a high resolution ultrasound machine to get a look at the heart. This requires special training and skills, because it can be difficult to get and to read a clear image of the heart. A doctor might recommend this if a routine ultrasound shows signs of a problem with the heart, or if there are other reasons to believe that something might be wrong with the heart. This allows the doctor to prepare for labor and delivery.
In transthoracic pediatric echocardiography, the doctor uses an ultrasound transducer pressed against the child's chest. This test is non-invasive, although it sometimes is uncomfortable because the conductive gel might be cold, and sometimes the doctor has to press very hard to see the heart clearly. The imaging study might be performed before surgery or if a child shows signs of a heart problem and the doctor wants to get a clear picture to decide how to proceed.
The more invasive transesophageal procedure provides a much better view of the heart. For this pediatric echocardiography study, the doctor puts the transducer down the patient's esophagus to look at the heart. The patient might need sedation and other medications. This procedure takes place in a clinic with care providers to monitor the patient for distress while the doctor gets images of the heart. The more invasive nature of the procedure makes it less popular, but the resulting clear image is highly beneficial.
Some facilities have the capacity for three-dimensional (3-D) pediatric echocardiography, in which a computer will reconstruct the images to create a 3-D model of the heart. This can be useful for studying the heart in preparation for a procedure, because the surgeon can manipulate the image to get a complete overview so that he knows what to expect. To get more information, a doctor might recommend magnetic resonance imaging of the heart in addition to echocardiography.