 Good morning to all the faculties and delegates. Myself, Dr. Kumal, I am a third year PG resident in Department of Radio Diagnosis from Maharishi Markandeshwar University, Mulana. My topic of today's presentation is Fetal Echocardiography for Early Detection of Congenital Heart Disease. Fetal ecocardiography represents one of the most exciting and rapidly evolving areas in the field of pediatric cardiology. The increasing advances in prenatal diagnosis, ability to intervene medically, percutaneously and perhaps surgically on the fetus has enhanced the importance of prenatal detection of congenital heart disease. Fetal ecocardiography is completely non-invasive, it is harmless and is the best tool in this direction. In this paper, we present analysis of fetal ecocases which were referred to the Tertiary Cardric Center. So, total number of cases that we have taken are 478 and the study was performed for about 5.5 years duration. The patients were taken from the local city having a population of around 1.5 million with a birth rate of 14.2 and expected birth of congenital heart disease babies is being 6 to 8 per thousand live birds. Detailed regarding the gestational age, maternal and family history, exposure to teritogens and reason for referral were recorded. Through curvilinear probe, we made the standard views and the views were four chamber view, outflow track views, three vessel view, aortic and ductal arc views. The average gestational age at the referral was 24 plus minus four weeks and the maternal age was 24 years. The referral were of abnormal fetal cardric scan, previous siblings suffering from the congenital heart disease, maternal indications, maternal indications like congenital and the rheumatic heart disease, mothers suffering with diabetes mellitus, with SLE, tuberous sclerosis, having the history of birth ingestion, then others were ecogenic intracardric focus, then other extracardric malformations. So the patients who were referred for abnormal fetal cardric scan, out of them 68% were of abnormal four chamber view, 17% for cardiomegaly, 8.6 for abnormal outflow track view, 2.3% for abnormal access and other were 3.1%. So 128 patients were there with abnormal scan, 99 patients with previous siblings with congenital heart disease, 87 with maternal indications, 87 with ecogenic intracardric focus, 50 with high risk and 21 with arrhythmia. So out of that, 268 patients were found normal, 86 were found to have congenital heart disease, 103 patients with ecogenic intracardric focus, 17 patients with arrhythmias and the females, there were about 66% of the females with gestational age more than 22 weeks, 14% with gestational age less than 20 weeks and around 17% with gestational age more than or around 18 to 20 weeks. So various type of congenital heart diseases that were diagnosed were ventricular septal defect, hypoplastic left heart syndrome, hypoplastic right heart syndrome, atrioventricular septal defect, right atrium and right ventricle dilated tricuspid atresia, tetralogy of fallot, single atrium, single ventricle, truncus arteriosus, tetralogy of fallot with absent pulmonary valve and double outlet right ventricle, tetralogy of fallot with pulmonary atresia, co-actation of aorta, severe tricuspid regurgitation, abstin with severe tricuspid regurgitation, dextrocardia and CTGV that is congenitally corrected transposition of great vessels. So here is the image showing a female with 26 weeks old fetus and here we see ventricular septal defect and overriding of aorta, this is the aorta and this is the ventricular septal defect and on color comparison we see the aorta is having connection with both the ventricles. Then another female with 30 weeks of gestation showing a hypoplastic, hypoplastic left ventricle, another patient with hypoplastic right ventricle. Then 26 weeks of gestation of female, here there is absent pulmonary valve and on color Doppler we see pulmonary regurgitation and stenosis. Then in a figure four chamber view with gestational age of 24 weeks showing single atrium with multiple ventricular septal defect, this is a single atrium and here are multiple ventricular defects. Then in image B four chamber view in 24 weeks old fetus and here the arrow is showing a atritic tricuspid valve which is suggestive of tricuspid atria. Then again a four chamber view in a patient with high drops showing hugely dilated right atrium with severe tricuspid regurgitation. Then another patient with 25 weeks of gestation with abstin and normally with the severe tricuspid regurgitation. So the main reason for referral for fetal echo in our study was abnormal cardric scan and which was found in 128 patients. The high incidence of echogenic intracardric focus which was found in our study was because of the parental anxiety because the parents wants to have a second opinion and the cases which were having a previous history of siblings suffering from the congenital heart disease was 99 which was probably due to our center performing pediatric cardric surgeries. The optimal time for the performance of comprehensive trans abdominal fetal echo was around 18 to 22 weeks. In India the upper limit of medical medical legal termination of pregnancy is at 20 weeks. On correlation of our result with referral indication the highest yield of congenital heart disease was in patient with abnormal fetal cardric scan. In the cases with arrhythmia one case had an association with SLD otherwise there was no congenital heart diseases found. In our study no CHD was detected in patients who were referred for various maternal indication like diabetes, hypothyroidism, hypertension. One patient with tuberous sclerosis had Repdo Myomas. In five patients with drug injection three had complex congenital heart diseases. The low association of CHD with fetal arrhythmias and maternal diabetes and fetal echo genic intracardric focus is seen in our study is similar to be noted in some previous reports and also the very low prevalence of extracardic anomalies in our study population is likely to be likely to be due to under reporting. So the limitation the limitation in our study are that the information regarding the precise actual diagnosis was incomplete as many patients who opted for pregnancy termination refused a topsy and only a few came for follow-up and also the operator was aware of all the referral indicators, indications. So the conclusion is early fetal echo can effectively identify abnormal heart and prenatal therapy has enhanced the survivor. The main concern in the Indian scenario is late referral. Late referrals to dedicated center especially in high risk patient will hopefully facilitate a better outcome for the neonate with CHD. However, ecocardiography screening after birth may not be too late for management. Thank you.