Prenatal features of ductus arteriosus constriction and restrictive foramen ovale in d-transposition of the great arteries

• Published in: Circulation (New York, N.Y.) Vol. 99; no. 9; pp. 1209 - 1214
• Main Authors: MAENO, Y. V, KAMENIR, S. A, SINCLAIR, B, VAN DER VELDE, M. E, SMALLHORN, J. F, HORNBERGER, L. K
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 09.03.1999; American Heart Association, Inc
• Subjects: Biological and medical sciences; Cardiology. Vascular system; Congenital heart diseases. Malformations of the aorta, pulmonary vessels and vena cava; Constriction, Pathologic - complications; Constriction, Pathologic - diagnosis; Constriction, Pathologic - mortality; Ductus Arteriosus - abnormalities; Ductus Arteriosus - diagnostic imaging; Echocardiography; Heart; Heart Septal Defects, Atrial - complications; Heart Septal Defects, Atrial - diagnosis; Heart Septal Defects, Atrial - mortality; Heart Septal Defects, Ventricular - complications; Heart Septum - diagnostic imaging; Humans; Infant, Newborn; Medical sciences; Predictive Value of Tests; Prenatal Diagnosis; Radiography; Transposition of Great Vessels - complications; Transposition of Great Vessels - diagnosis; Transposition of Great Vessels - mortality; Sonography; Human; Echocardiography; Prognosis; Clinical form; Stenosis; Cardiovascular disease; Ductus arteriosus; Congenital disease; Vascular disease; Newborn; Heart disease; Fetus; Transposition of the great vessels; Ostium secundum
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/01.cir.99.9.1209

Although most neonates with d-transposition of the great arteries (TGA) have an uncomplicated preoperative course, some with a restrictive foramen ovale (FO), ductus arteriosus (DA) constriction, or pulmonary hypertension may be severely hypoxemic and even die shortly after birth. Our goal was to determine whether prenatal echocardiography can identify these high-risk fetuses with TGA. We reviewed the prenatal and postnatal echocardiograms and outcomes of 16 fetuses with TGA/intact ventricular septum or small ventricular septal defect. Of the 16 fetuses, 6 prenatally had an abnormal FO (fixed position, flat, and/or redundant septum primum). Five of the 6 had restrictive FO at birth. Five fetuses had DA narrowing at the pulmonary artery end in utero, and 6 had a small DA (diameter z score of <-2.0). Of 4 fetuses with the most diminutive DA, 2 also had an abnormal appearance of the FO, and both died immediately after birth. One other fetus had persistent pulmonary hypertension. Eight fetuses had abnormal Doppler flow pattern in the DA (continuous high-velocity flow, n=1; retrograde diastolic flow, n=7). Abnormal features of the FO, DA, or both are present in fetuses with TGA at high risk for postnatal hypoxemia. These features may result from the abnormal intrauterine hemodynamics in TGA. A combination of restrictive FO and DA constriction in TGA may be associated with early neonatal death.