Unmasking the Placenta–Heart Axis: A Comprehensive Review of Placental Abnormalities in Congenital Heart Disease

Congenital heart disease (CHD), the most prevalent congenital abnormality, is becoming increasingly acknowledged as a component of a broad fetoplacental pathology. This systematic review summarizes recent imaging-based data linking CHD to quantifiable placental abnormalities. In CHD pregnancies, placenta studies consistently show patterns of altered vascularization, decreased volumetric growth, microstructural heterogeneity, and impaired placental oxygenation. We conducted a thorough literature search from January 2020 to May 2025 to identify studies on placenta function and structure in CHD-affected pregnancies. The included studies primarily utilized MRI and Doppler methods, as well as some modern modalities. Seven studies were included in this review. Placental imaging reveals consistent structural and functional abnormalities in pregnancies affected by congenital heart disease, indicating some possible contribution of the placenta in CHD pathophysiology. Placental imaging may improve outcomes in this susceptible group of pregnancies, improve risk assessment, and direct surveillance when incorporated into prenatal care for congenital heart disease. Future research should concentrate on lesion-specific analysis, longitudinal imaging, and placenta–heart axis-targeting treatment therapies.