The recognition of congenital heart disease (CHD) during ‘routine’ obstetric anomaly scans continues to be a challenge. Recent national guidance has strengthened previous recommendations and advocated the incorporation of views of cardiac situs, four-chamber view and outflow tracts into such scans.1 An increasingly important question is how fetal cardiologists can best support district hospitals, first in terms of training and second to provide support if a cardiac abnormality is suspected. The article by McCrossan and colleagues in this month's journal2 provides an important contribution relating to the role of telemedicine in the delivery of a system for prenatal detection and management of CHD. These authors reported on several facets of the application of telemedicine in fetal cardiology practice including technical feasibility, service organisation and quality control.

From a technical perspective, application of telemedicine to the fetal heart demands high spatial and temporal resolution due to the small size of the fetal heart and rapid heart rate. With availability of the appropriate equipment in the district and tertiary hospital coupled with sufficient bandwidth for image transfer, the study of McCrossan reported a high degree of satisfaction with the image quality received at the remote tertiary site, with image scores that were, unsurprisingly, higher in those cases with favourable fetal lie. This permitted reassurance of normality in a significant number of cases where …