Role of maternal hyperoxygenation in predicting need for postnatal balloon atrial septostomy in fetal d‐transposition of the great arteries

• Published in: Ultrasound in obstetrics & gynecology Vol. 64; no. 5; pp. 589 - 596
• Main Authors: Szwast, A., Penney, C., Sharma, P., Rychik, J.
• Format: Journal Article
• Language: English
• Published: Chichester, UK John Wiley & Sons, Ltd 01.11.2024; Wiley Subscription Services, Inc
• Subjects: Adult; Arteries; Atrial Septum - diagnostic imaging; Atrial Septum - embryology; Balloons; congenital heart disease; Doppler effect; d‐TGA; Echocardiography - methods; Female; fetal echocardiography; Fetal Heart - diagnostic imaging; Fetuses; Gestational Age; Gynecology; Humans; Infant, Newborn; maternal hyperoxygenation; Obstetrics; Postpartum period; Predictive Value of Tests; Pregnancy; Retrospective Studies; Transposition; Transposition of Great Vessels - diagnostic imaging; Transposition of Great Vessels - embryology; Transposition of Great Vessels - surgery; Two dimensional analysis; Ultrasonography, Prenatal - methods; Ventricle; congenital heart disease; maternal hyperoxygenation; fetal echocardiography; d‐TGA
• ISSN: 0960-7692; 1469-0705; 1469-0705
• DOI: 10.1002/uog.27664

ABSTRACT Objective Predicting whether postnatal balloon atrial septostomy (BAS) will be necessary for fetuses with dextro‐transposition of the great arteries (d‐TGA) remains challenging. We sought to determine whether fetal echocardiographic measurements obtained during maternal hyperoxygenation (MH) can improve our ability to predict the need for postnatal BAS. Methods This was a retrospective, single‐institution review of d‐TGA fetuses whose mothers had undergone MH at 33–38 weeks' gestation at the Children's Hospital of Philadelphia, between 1 January 2017 and 30 March 2020. All fetal d‐TGA cases had either an intact ventricular septum or small ventricular septal defect measuring < 3 mm. Patent foramen ovale (PFO) size, measured by two‐dimensional imaging (2D) and by color Doppler, and patent ductus arteriosus (PDA) shunting (antegrade vs bidirectional) were assessed in room air (RA) and during MH. BAS status and timing were recorded. Results Of 41 fetal d‐TGA cases in the cohort, 23 underwent postnatal BAS, while 18 did not, and 14 subjects underwent emergent BAS within 3 h of delivery. On univariate analysis, PFO size measured both in RA and during MH and antegrade shunting in the PDA during MH predicted BAS. During MH, median PFO size by 2D was significantly smaller in fetuses which underwent emergent BAS compared to fetuses which did not undergo BAS (2.5 (interquartile range (IQR), 2.0–3.0) mm vs 4.1 (IQR, 3.4–5.0) mm; P < 0.001). On cut‐point analysis, PFO size by 2D during MH of ≤ 3.2 mm predicted the need for emergent BAS with a sensitivity of 93% (95% CI, 66–100%) and a specificity of 78% (95% CI, 58–91%). Conclusions In fetuses with d‐TGA, measurement of PFO size and direction of PDA shunting during MH improves our ability to predict the need for postnatal BAS, although additional study is needed. We propose incorporating third‐trimester MH when planning delivery of a d‐TGA fetus. © 2024 International Society of Ultrasound in Obstetrics and Gynecology.