Abstract
Objective: To review our series of prenatally diagnosed transposition of the great arteries (TGA) to analyze the accuracy of fetal echocardiography for achieving a precise diagnosis of the TGA type (simple vs. complex) and to examine the short-term outcome. Methods: A total of 94 cases of simple and complex TGA types (ventriculoarterial discordance with atrioventricular concordance) prenatally evaluated in our referral center between 1998 and 2014 were included. Fetuses with additional congenital anomalies and those with incomplete follow-up were excluded. Prenatal diagnostic accuracy and short-term survival were analyzed for the different types of TGA. Results: The TGA type was correctly ascertained prenatally in 93.3%. Most fetuses were diagnosed with simple TGA (62.7%). There were 6 discrepancies: 5 fetuses with simple TGA had postnatally TGA + ventricular septal defect (VSD; n = 3) or TGA + VSD + coarctation of the aorta (n = 2), and 1 fetus with TGA + VSD postnatally showed severe left ventricular outflow tract obstruction. The mortality rate was 6.6%; it was higher in complex versus simple forms (12.8 vs. 1.9%, p = 0.038), and in cases with intramural coronary artery versus those without (60 vs. 3.5%, p < 0.001). We found no relationship between the arrangement of the great arteries and coronary arterial abnormalities. Conclusions: Simple TGA has a better outcome than the complex forms. A discrepancy rate of 7% with potential influence on the prognosis of survival between the prenatal diagnosis of the TGA type and the definitive diagnosis was found.
References
1.
Martins P, Castela E: Transposition of the great arteries. Orphanet J Rare Dis 2008;3:27.
2.
Liebman J, Cullum L, Belloc NB: Natural history of transposition of the great arteries. Anatomy and birth and death characteristics. Circulation 1969;40:237-262.
3.
Bennasar M, Gómez O, Bartrons J: Transposición de grandes vasos; in Galindo A, Gratacós E, Martínez JM (eds): Cardiología Fetal. Madrid, Marban, 2015, pp 357-367.
4.
Galindo A, Mendoza A, Arbues J, Grañeras A, Escribano D, Nieto O: Conotruncal anomalies in fetal life: accuracy of diagnosis, associated defects and outcome. Eur J Obstet Gynecol Biol Reprod 2009;146:55-60.
5.
Fricke TA, d'Udekem Y, Richardson M, Thuys C, Dronavalli M, Ramsay JM, Wheaton G, Grigg LE, Brizard CP, Konstantinov IE: Outcomes of the arterial switch operation for transposition of the great arteries: 25 years of experience. Ann Thorac Surg 2012;94:139-145.
6.
Parezanović V, Mrdjen M, Illić S, Vulićević I, Djukić M, Jovanović I, Stefanović I, Illisić T, Kalanj J, Mimic B, Milovanović V: Mid-term results after complete surgical correction of transposition of the great arteries. Srp Arh Celok Lek 2014;142:306-313.
7.
Turon A, Riverola A, Moreno J, Bartrons J, Prada FH, Mayol J, Caffarena JM: Characteristics and outcomes of transposition of great arteries in the neonatal period. Rev Esp Cardiol 2014;67:114-119.
8.
Dibardino DJ, Allison AE, Vaughn WK, McKenzie ED, Fraser CD: Current expectations for newborns undergoing the arterial switch operation. Ann Surg 2004;239:588-596.
9.
Prifti E, Crucean A, Bonacchi M, Bernabei M, Murzi B, Luisi SV, Vanini V: Early and long-term outcome of the arterial switch operation for transposition of the great arteries: predictors and functional evaluation. Eur J Cardiothorac Surg 2002;22:864-873.
10.
Wong SH, Finucane K, Kerr AR, O'Donnell C, West T, Gentles TL: Cardiac outcome up to 15 years after the arterial switch operation. Heart Lung Circ 2008;17:48-53.
11.
Escobar MC, Freud LR, Bueno A, Brown DW, Friedman K, Schidlow D, Emani S, del Nido P, Tworetzky W: Prenatal diagnosis of transposition of the great arteries over a 20-year period: improved but imperfect. Ultrasound Obstet Gynecol 2015;45:678-682.
12.
Rychik J, Ayres N, Cuneo B, Gotteiner N, Hornberger L, Spevak PJ, Van Der Veld M: American Society of Echocardiography guidelines and standards for performance of the fetal echocardiogram. J Am Soc Echocardiogr 2004;17:803-810.
13.
Satomi G: Guidelines for fetal echocardiography. Pediatr Int 2015;57:1-21.
14.
Tongson T, Tongprasert F, Srisupundit K, Luewan S: The complete three-vessel view in prenatal detection of congenital heart defects. Prenat Diagn 2010;30:23-29.
15.
Pasquini L, Sanders SP, Parness IA, Wernovsky G, Mayer JE, Van Der Velde ME, Spevak PJ, Colan S: Coronary echocardiography in 406 patients with d-loop transposition of the great arteries. J Am Coll Cardiol 1994;24:763-768.
16.
Massoudy P, Baltalarli A, de Leval MR, Cook A, Neudorf U, Derrick G, McCarthy KP, Anderson RH: Anatomic variability in coronary arterial distribution with regard to the arterial switch procedure. Circulation 2002;106:1980-1984.
17.
Pasquali SK, Hasselblad V, Li JS, Kong DF, Sanders SP: Coronary artery pattern and outcome of arterial switch operation for transposition of the great arteries: a meta-analysis. Circulation 2002;106:2575-2580.
18.
Lacour-Gayet F, Clarke D, Jacobs J, Gaynor W, Hamilton L, Jacobs M, Maruszewski B, Pozzi M, Spray T, Tchervenkov C, Mavroudis C; Aristotle Committee: The Aristotle score for congenital heart surgery. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2004;7:185-191.
19.
Maeno YV, Kamenir SA, Sinclair B, Van Der Velde ME, Smallhorn JF, Hornberger LK: Prenatal features of ductus arteriosus constriction and restrictive foramen ovale in d-transposition of the great arteries. Circulation 1999;99:1209-1214.
20.
Jouannic JM, Gavard L, Fermont L, Le Bidois J, Parat S, Vouhé PR, Dumez Y, Sidi D, Bonnet D: Sensitivity and specificity of prenatal features of physiological shunts to predict neonatal clinical status in transposition of the great arteries. Circulation 2004;110:1743-1746.
21.
Pettersen MD, Du W, Skeens ME, Humes RA: Regression equations for calculation of z scores of cardiac structures in a large cohort of healthy infants, children, and adolescents: an echocardiographic study. J Am Soc Echocardiogr 2008;21:922-934.
22.
Tometzki AJ, Suda K, Kohl T, Kovalchin JP, Silverman NH: Accuracy of prenatal echocardiographic diagnosis and prognosis of fetuses with conotruncal anomalies. J Am Coll Cardiol 1999;33:1696-1701.
23.
Paladini D, Rustico M, Todros T, Palmieri S, Gaglioti P, Benettoni A, Russo MG, Chiappa E, DʼOttavio G: Conotruncal anomalies in prenatal life. Ultrasound Obstet Gynecol 1996;8:241-246.
24.
Vaidyanathan B, Kumar S, Sudhakar A, Kumar RK: Conotruncal anomalies in the fetus: referral patterns and pregnancy outcomes in a dedicated fetal cardiology unit in South India. Ann Pediatr Cardiol 2013;6:15-20.
25.
Allan LD, Huggon IC: Counselling following a diagnosis of congenital heart disease. Prenat Diagn 2004;24:1136-1142.
26.
Gardiner HM: Fetal echocardiography: 20 years of progress. Heart 2001;86(suppl ii):12-22.
27.
Hartge DR, Weichert J, Krapp M, Germer U, Gembruch U, Axt-Fliedner R: Results of early foetal echocardiography and cumulative detection rate of congenital heart disease. Cardiol Young 2011;21:505-517.
28.
Kim JW, Gwak M, Shin WJ, Kim HJ, Yu JJ, Park PH: Preoperative factors as a predictor for early postoperative outcomes after repair of congenital transposition of the great arteries. Pediatr Cardiol 2015;36:537-542.
29.
Sivanandam S, Glickstein JS, Printz BF, Allan LD, Altmann K, Solowiejczyk DE, Simpson L, Perez-Delboy A, Kleinman CS: Prenatal diagnosis of conotruncal malformations: diagnostic accuracy, outcome, chromosomal abnormalities, and extracardiac anomalies. Am J Perinatol 2006;23:241-245.
30.
Boudjemline Y, Fermont L, Le Bidois J, Lyonnet S, Sidi D, Bonnet D: Prevalence of 22q11 deletion in fetuses with conotruncal cardiac defects: a 6-year prospective study. J Pediatr 2001;138:520-524.
31.
Goldmuntz E, Clark BJ, Mitchell LE, Jawad AF, Cuneo BF, Reed L, McDonald-McGinn D, Chien P, Feuer J, Zackai EH, Emanuel BS, Driscoll DA: Frequency of 22q11 deletions in patients with conotruncal defects. J Am Coll Cardiol 1998;32:492-498.
32.
Khairy P, Clair M, Fernandes SM, Blume ED, Powell AJ, Newburger JW, Landzberg MJ, Mayer JE: Cardiovascular outcomes after the arterial switch operation for D-transposition of the great arteries. Circulation 2013;127:331-339.
33.
Van Velzen CL, Haak MC, Reijnders G, Rijlaarsdam ME, Bax CJ, Pajkrt E, Hruda J, Galindo-Garre F, Bilardo CM, de Groot CJ, Blom NA, Clur SA: Prenatal detection of transposition of the great arteries reduces mortality and morbidity. Ultrasound Obstet Gynecol 2015;45:320-325.
34.
Clur SA, Van Brussel PM, Ottenkamp J, Bilardo CM: Prenatal diagnosis of cardiac defects: accuracy and benefit. Prenat Diagn 2012;32:450-455.
35.
García-Hernández JA, Montero-Valladares C, Martínez-López AI, Gil-Fournier M, Praena-Fernández JM, Cano-Franco J, Loscertales-Abril M: Prognostic evaluation of arterial switch in the transposition of great arteries (in Spanish). An Pediatr (Barc) 2011;74:174-181.
36.
Qamar ZA, Goldberg CS, Devaney EJ, Bove EL, Ohye RG: Current risk factors and outcomes for the arterial switch operation. Ann Thorac Surg 2007;84:871-879.
37.
Sarris GE, Chatzis AC, Giannopoulus NM, Kirvassilis G, Berggren H, Hazekamp M, Carrel T, Comas JV, Di Carlo D, Daenen W, Ebels T, Fragata J, Hraska V, Ilyin V, Lindberg HL, Metras D, Pozzi M, Rubay J, Sairanen H, Stellin G, Urban A, Van Doorn C, Ziemer G: The arterial switch operation in Europe for transposition of the great arteries: a multi-institutional study from the European Congenital Heart Surgeons Association. J Thorac Cardiovasc Surg 2006;132:633-639.
38.
Bonnet D, Coltri A, Butera G, Fermont L, Le Bidois J, Kachaner J, Sidi D: Detection of transposition of the great arteries in fetuses reduces neonatal morbidity and mortality. Circulation 1999;99:916-918.
39.
Yamaguchi M, Hosokawa Y, Imai Y, Kurosawa H, Yasui H, Yagihara T, Okamoto F, Wakaki N: Early and midterm results of the arterial switch operation for transposition of the great arteries in Japan. J Thorac Cardiovasc Surg 1990;100:261-269.
40.
García-Hernández JA, Montero-Valladares C, Martínez-López AI, Romero Parreño A, Grueso Montero J, Gil-Fournier Carazo M, Cayuela Domínguez A, Loscertales Abril M, Tovaruela Santos A: Risk factors associated with arterial switch operation for transposition of the great arteries (in Spanish). Rev Esp Cardiol 2005;58:815-821.
41.
Paladini D, Volpe P, Sglavo G, Vasallo M, De Robertis V, Masarini M, Russo MG: Transposition of the great arteries in the fetus: assessment of the spatial relationships of the arterial trunks by four-dimensional echocardiography. Ultrasound Obstet Gynecol 2008;31:271-276.
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