Asian Journal of Pregnancy and Childbirth

Congenital heart defects (CHDs) remain the most common congenital anomalies worldwide and represent a leading cause of infant morbidity and mortality. Advances in fetal cardiology—particularly in fetal echocardiography—have transformed early detection and perioperative management of these conditions. The paper aims to examine how advanced fetal echocardiography aids in diagnosing congenital heart defects and guides surgical planning for improved neonatal outcomes. This review highlights the expanding role of advanced fetal echocardiography in optimising congenital heart surgery planning, bridging the continuum of care from prenatal diagnosis to interventions in the operating room. High-resolution imaging modalities, including three-dimensional and four-dimensional echocardiography, speckle-tracking echocardiography, and fetal cardiac magnetic resonance imaging (MRI) integration, now allow detailed visualisation of intracardiac anatomy and hemodynamics. Such enhancements facilitate accurate identification of critical lesions such as hypoplastic left heart syndrome, transposition of the great arteries, and tetralogy of Fallot, guiding decisions regarding timing and mode of delivery, neonatal stabilisation, and the need for early surgical intervention. Moreover, fetal echocardiography supports multidisciplinary counselling, enabling cardiologists, maternal–fetal medicine specialists, neonatologists, and cardiothoracic surgeons to collaboratively formulate individualised surgical roadmaps. Emerging techniques, including virtual and printed three-dimensional cardiac models, provide surgeons with the ability to simulate complex repairs before birth, reducing perioperative risk. The study showed that diagnostic sensitivities surpassing 90% in tertiary care centres for major CHDs, including hypoplastic left heart syndrome (HLHS), transposition of the great arteries (TGA), and atrioventricular septal defects. Clinical evidence demonstrates that fetuses diagnosed prenatally with complex CHDs experience improved outcomes due to proactive surgical preparedness and streamlined postnatal management. Despite these promising developments, challenges persist, particularly in low-resource settings where accessibility remains limited. Standardisation of imaging protocols, expanded training, and tele-echocardiography platforms are essential to ensure equitable global utilisation. Continued research in fetal cardiac biomechanics and machine learning-assisted interpretation may further enhance prognostic accuracy. Overall, advanced fetal echocardiography has become a cornerstone of modern congenital heart surgery planning. By shifting crucial decision-making into the prenatal period, it improves survival, reduces surgical complications, and enhances long-term quality of life for affected children.