Introduction
There remains a disparity between, and within, regions in access to fetal cardiology and detection rates of congenital heart disease (CHD). We aimed to evaluate the feasibility, accuracy and patient acceptability of remote fetal echocardiograms (FE).

Methods
Prospective study over 20 month period. An initial FE was performed by a radiographer in the district general hospital (DGH) (D1) followed by a second FE transmitted to the regional centre, in real time, via a telemedicine link (384Kbps) with live guidance by a fetal cardiologist (D2). A FE was performed later at the regional centre (D3, gold standard). Identical questionnaires were completed at DGH and regional centre relating to satisfaction with the consultation and preferred method of FE (5-point Likert scale.

Results
69 remote FE have been performed: 58 normal hearts and 11 with CHD (3 duct dependent) confirmed by D3. D2 was accurate in 97% cases compared with D3 (kappa score = 0.90) indicating excellent agreement. Respondents preferred to have the FE performed by tele-link at the DGH: Mean difference = 1.6 (p<0.01). The mean satisfaction scores for telemedicine and “hands-on” consultations were high, 46.6/50 and 46.5/50 respectively.

Discussion
To date this is the largest study of its kind. CHD can be confidently diagnosed and excluded by remote FE. Pregnant women prefer to have the FE performed at their local hospital via telemedicine. This application of telemedicine could improve access to fetal cardiology, support radiographers screening for CHD and reduce the burden on the limited capacity of tertiary centres.