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.
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http://dx.doi.org/10.1002/uog.27664 | DOI Listing |
J Am Soc Echocardiogr
January 2025
Division of Pediatric Cardiology, Department of Pediatrics, Stanford School of Medicine, Stanford, CA.
J Am Soc Echocardiogr
January 2025
Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, Westminster Bridge Road, London SE1 7EH, UK; School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK.
Background: Newborns with transposition of the great arteries (TGA) are at risk of severe hypoxia from inadequate atrial mixing, closure of the arterial duct and/or pulmonary hypertension (PPHN). Acute maternal hyperoxygenation (AMH) might assist in identifying at-risk fetuses. We report pulmonary vasoreactivity to AMH in TGA fetuses and its relationship to early postnatal hypoxia and requirement for emergency balloon atrial septostomy (e-BAS).
View Article and Find Full Text PDFUltrasound Obstet Gynecol
November 2024
Division of Pediatric Cardiology, Ann and Robert H Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Ultrasound Obstet Gynecol
November 2024
Fetal Heart Program, Division of Pediatric Cardiology, Children's Hospital of Philadelphia and University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
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.
CJC Pediatr Congenit Heart Dis
February 2024
The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
The field of fetal cardiology has evolved significantly in recent years. This review focuses on specific advances in fetal cardiac imaging and intervention that are increasingly used in clinical practice. On the imaging frontier, updated screening guidelines and artificial intelligence hold promise for improving prenatal detection of congenital heart disease.
View Article and Find Full Text PDFEnter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!