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Reliability of Fetal Echocardiography in Predicting Postnatal Critical Hypoxia in Patients with Transposition of Great Arteries and Intact Ventricular Septum

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Abstract

Critical hypoxemia soon after birth is the most critical preoperative determinant of neurological outcomes and survival in newborns with Dextro Transposition of the Great Arteries and Intact Ventricular Septum (D-TGAIVS). Our study aimed to define fetal echocardiographic aspects that can better predict neonates with D-TGAIVS at risk for restricted interatrial communication after birth. 31 fetuses with a prenatal diagnosis of D-TGAIVS were included in our study. We divided patients with D-TGAIVS according to the timing of balloon atrial septostomy: Urgent, Not-Urgent and no BAS. We identified five fetal echocardiographic aspects of the interatrial septum (redundant, aneurysmal, flat, fixed, hypermobile). No significant differences in these fetal echocardiographic features were found between the three different groups of D-TGAIVS according to the timing of balloon atrial septostmy. However, only two patients showed flat appearance of interatrial communication: both needed Urgent balloon atrial septostomy. The prevalence of hypermobile septum primum was significantly lower in the control group compared to patients with D-TGAIVS. Fetal echocardiographic aspects cannot predict patients with D-TGAIVS who will not need Urgent balloon atrial septostomy. Therefore, we recommended a delivery in a tertiary center, equipped for Urgent balloon atrial septostomy, for all patients with D-TGAIVS regardless of fetal echocardiographic features.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Perinatal Cardiology Unit, Department of Medical and Surgical for Fetus-Neonate, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy

    M. Masci, L. Pasquini, C. M. Campanale & A. Toscano

  2. Heart Institute Department of Pediatrics, Cincinnati Children’s Hospital Medical Center University of Cincinnati, Cincinnati, OH, USA

    T. Alsaied

  3. Pediatric Cardiac Intensive Care Unit, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy

    L. Di Chiara

  4. Cardiac Hemodynamics Unit, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children Hospital-IRCSS, Rome, Italy

    R. Formigari

  5. Pediatric Cardiac Surgery Unit, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy

    L. Galletti

  6. Fetal Medicine and Surgery Unit, Department of Medical and Surgical for Fetus-Neonate, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy

    A. Romiti

  7. Department of Obstetrics and Gynecology, San Pietro Fatebenefratelli Hospital, Rome, Italy

    M. Bonito

  8. Neonatal Surgery Unit, Department of Medical and Surgical for Fetus-Neonate, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy

    P. Bagolan

Authors
  1. M. Masci
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  2. L. Pasquini
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  3. T. Alsaied
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  4. L. Di Chiara
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  5. R. Formigari
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  6. L. Galletti
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  7. C. M. Campanale
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  8. A. Romiti
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  9. M. Bonito
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  10. P. Bagolan
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  11. A. Toscano
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Contributions

AT: study design, LP: coordinated study, MM, TA: major contributors in writing the manuscript; MM, TA, AT: analyzed and interpreted patient data. All authors read and approved the final manuscript. All authors contributed to the design, data analysis and critically read the final manuscript.

Corresponding author

Correspondence to L. Pasquini.

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The authors declare that they have no conflict of interest.

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The study was approved by the Institution Review Board.

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Masci, M., Pasquini, L., Alsaied, T. et al. Reliability of Fetal Echocardiography in Predicting Postnatal Critical Hypoxia in Patients with Transposition of Great Arteries and Intact Ventricular Septum. Pediatr Cardiol 42, 1575–1584 (2021). https://doi.org/10.1007/s00246-021-02642-w

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  • DOI: https://doi.org/10.1007/s00246-021-02642-w

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