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Substantial obstacles usually face the initiation of fetal cardiac service from scratch in LMICs. The primary structural frame of a successful fetal cardiac program is described in detail, emphasizing the required team members. The potential challenges for starting fetal cardiac services in LMICs include financial, awareness-related, prenatal obstetric screening, sociocultural, psychosocial, and social support factors. These challenges could be solved by addressing these barriers, such as collecting funds for financial support, raising awareness among families and health care providers, telemedicine, building international health partnerships, modifying training protocols for fetal cardiologists and sonographers, and initiating support groups and social services for families with confirmed fetal cardiac disease. Initiating a successful fetal cardiac program requires multi-aspect structural planning. The challenges for program initiation require diverse efforts, from modified training and promoting awareness of care providers and the community to governmental and nonprofit organizations\u2019 collaborations for proper building and utilization of program resources.<\/jats:p>","DOI":"10.1007\/s00246-024-03479-9","type":"journal-article","created":{"date-parts":[[2024,4,19]],"date-time":"2024-04-19T15:01:37Z","timestamp":1713538897000},"page":"257-266","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Initiating a Fetal Cardiac Program from Scratch in Low- and Middle-Income Countries: Structure, Challenges, and Hopes for Solutions"],"prefix":"10.1007","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9115-910X","authenticated-orcid":false,"given":"Shaimaa","family":"Rakha","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,4,19]]},"reference":[{"issue":"3","key":"3479_CR1","doi-asserted-by":"publisher","first-page":"152","DOI":"10.1097\/00004424-197205000-00004","volume":"7","author":"F Winsberg","year":"1972","unstructured":"Winsberg F (1972) Echocardiography of the fetal and newborn heart. 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