Demographic Data Collection

We collected all fetal and neonatal patients with complete transposition from our reference database using the syngo Dynamics workstation (Siemens Medical Solutions USA, Inc., Ann Arbor, MI). We reviewed all data from January 1, 2001, to June 30, 2010. All newborns with a prenatal diagnosis of complete transposition of the great vessels and postnatal confirmatory echocardiograms were included in the study. Patients with a ventricular septal defect, double outlet right ventricle, or coarctation of the aorta were excluded from the study. Demographic data included gestational age at the time of fetal evaluation and date of birth. Neonatal records were examined for urgent need of BAS within a few hours of birth and decreased or increased oxygen saturation. At our institution, BAS is performed if a neonate has severe hypoxemia caused by inadequate circulatory mixing. Typically, our patients are intubated, mechanically ventilated, and placed on prostaglandin therapy before BAS. For the purpose of this study, neonates who required an urgent BAS were defined as having evidence of significant hypoxemia and a restrictive interatrial communication despite these interventions. The need for an urgent BAS was confirmed by reviewing the oxygen saturation data and carefully examining the interatrial septum for restriction on the initial postnatal study. Therefore, the urgent BAS subgroup in our series had both of the following: (1) oxygen saturation in the right upper arm ≤60% despite prostaglandin therapy and (2) an inadequate interatrial communication for circulatory mixing.

A lack of improvement would suggest pulmonary hypertension or an inadequate rupture of the septum primum. Any complications after a BAS were also recorded. Additional data gathered included initial arterial blood, need for intubation, timing of intubation, time of birth, method of delivery, and time of BAS if performed. This study was approved through our institution’s review board (Protocol 17194), and all data were made anonymous in accordance with the Health Insurance Portability and Accountability Act.

Echocardiographic Data Collection

Ultrasound equipment included the Siemens Acuson Machine C512, rev 12.0 (Siemens Medical Solutions USA, Inc., Mountain View, CA) and the Philips IE33 (Philips Medical Systems, Bothell, WA). The diagnosis of complete transposition was verified in both the fetal and multiple postnatal studies. Fetal echocardiograms were closely examined by the authors at the atrial and ductal levels. The atrial septum was appropriately profiled with the plane of the atrial septum oriented perpendicular to the ultrasound beam and examined for particular characteristics.

Atrial Septum In Utero

• 1.
  

  Hypermobile atrial septum: The septum primum oscillates between the left and the right atrium ( Figure 1 ). Video 1 ( view video clip online) is also available for the image in Figure 1 .

  
  
• 2.
  

  Redundant atrial septum: The septum primum herniates more than 50% beyond the plane of the septum secundum across the length of the left atrium, as described by Wilson et al. ( Figure 2 ).

  
  

  
  

  
  

  

  
  

  
  

  Redundant atrial septum. The aneurysmal septum primum flap ( arrowheads ) herniates deep into the left atrium, more than 50% across its entire length (patient 1 in Table 1 ). RV, Right ventricle; LV, left ventricle.

  
  
  
  
• 3.
  

  Restrictive atrial septum: A small orifice with color flow aliasing across the atrial septum is noted.

  
  
• 4.
  

  Fixed atrial septum: The angle between the septum primum and secundum is less than 30 degrees.

  
  
• 5.
  

  Flat atrial septum: No mobility of the atrial septum is noted.

Ductus Arteriosus In Utero

The size of the ductus was measured against reference standards for gestational age, and a z -score was determined ( Table 1 ). Color and spectral Doppler evaluation of the ductus was conducted to determine restriction or diastolic reversal of flow ( Figure 3 ). The first author carefully examined all prenatal and postnatal studies, and all prenatal assessments were made while blinded to the postnatal outcomes. In a subset of study patients, the ductal shunt direction and atrial septum were independently assessed by the senior author, who was also blinded to postnatal outcomes.

Table 1

Description of patients

Patient	Prenatal data					Postnatal data
	Gestational age (wk)	Ductus z -score	R-PDA	HMS	RED	Delivery	Other diagnoses	Urgent BAS	Initial SAT	BAS-SAT	Arterial blood gas	Ductal size
1	38	0.25	no	no	yes	vaginal	none	no	90%		7.20/43/18	large
2	27	1.08	no	yes	no	vaginal	none	yes	60%	70%–80%	7.26/46/22	large
3	34	−0.33	yes	no	no	vaginal	none	no	70%		7.29/32/16	large
4	21,21	0.33	no	no	no	vaginal	none	no	70%–80%		7.22/46/19	large
5	20,31	0.00	yes	yes	no	vaginal	none	yes	55%	79%	7.26/39/17	large
6	34	−0.25	no	yes	yes	vaginal	none	yes	30%	70%	7.29/43/21	moderate
7	31	−0.83	yes	yes	yes	vaginal	none	yes	35%	90%	7.12/37/12	large
8	26,32	0.58	yes	no	no	vaginal	none	yes	40%–50%	80%–90%	7.17/44/16	large
9	21,29	0.42	no	yes	no	caesarian	circ off RCA	yes	60%	80%	7.23/51/21	large
10	20,31	−0.25	yes	yes	no	vaginal	none	yes	30%–40%	90%	7/17/48/17	moderate ∗
11	27,28	1.92	no	no	yes	vaginal	circ off RCA	no	80%-90%		7.29/42/20	large
12	21	−0.25	yes	yes	no	caesarian	none	yes	60%–70%	80%–90%	7.25/45/20	large
13	21	0.33	yes	no	no	n/a	none	yes	60%–70%	80%–90%	n/a	large
14	23,36	−1.42	yes	no	no	vaginal	none	yes	30%	80%	7.25/22.5/10	large
15	22,28,36	−0.75	no	no	yes	vaginal	none	yes	20%	80%	7.22/50/21	large
16	28	0.00	no	no	yes	vaginal	none	no	80%–90%		7.27/44/20	large
17	35	−0.63	no	no	no	caesarian	none	no	80%–90%		7.21/60/24	large
18	37	−0.58	yes	yes	yes	vaginal	none	yes	50%–60%	80%	7.19/56/22	large
19	36	−0.25	no	no	yes	vaginal	none	no	70%–80%		7.32/43/23	large
20	31	−0.88	no	no	no	caesarian	none	no	80%–90%		7.29/49/23	large
21	35	0.63	no	yes	no	caesarian	none	yes	30%–50%	80%–90%	7.30/45/22	large
22	33	−0.42	no	no	no	vaginal	none	yes	50%–60%	80%–90%	7.31/42/22	large
23	37	−0.92	no	no	no	caesarian	none	no	90%		7.31/50/25	large
24	20,28	−0.50	no	no	no	caesarian	LSVC	no	80%–90%		7.26/58/26	large
25	34	0.25	no	no	yes	vaginal	none	no	80%–86%		7.30/37/18	large ∗
26	22	−0.17	no	no	yes	caesarian	none	no	81%–89%		7.30/41/20	large

Only gold members can continue reading. Log In or Register to continue

Share this:

• Click to share on Twitter (Opens in new window)
• Click to share on Facebook (Opens in new window)

Related

Related posts:

1. Neuropsychiatric Symptoms During 24 Hours after Dobutamine-Atropine Stress Testing: A Prospective Study in 1,006 Patients
2. Favorable Short-Term Outcome of Transplanted Hearts Selected from Marginal Donors by Pharmacological Stress Echocardiography
3. Quantitative Analysis of Mitral Valve Apparatus in Mitral Valve Prolapse Before and After Annuloplasty: A Three-Dimensional Intraoperative Transesophageal Study
4. Continuing Education and Meeting Calendar

Stay updated, free articles. Join our Telegram channel

Join