Comprehensive Functional Echocardiographic Assessment of Transposition of the Great Arteries: From Fetus to Newborn

Urgent neonatal balloon atrial septostomy in simple transposition of the great arteries: predictive value of fetal cardiac parameters

“…In agreement with this, our results revealed biventricular diastolic dysfunction in term fetuses with simple TGA, that was evident from reduced LV‐ and RV‐RT′ and prolonged RV‐IVRT′. Previous publications have reported different ventricular morphology and myocardial time‐interval values 16 and unchanged CCO with left CO preponderance in fetuses with simple TGA compared with controls 13,14 . These discrepancies can be explained by the retrospective design of these studies, inclusion of fetuses of less than 37 weeks' gestation and non‐adjustment of myocardial time intervals for the difference in fetal heart rate.…”

“…These discrepancies can be explained by the retrospective design of these studies, inclusion of fetuses of less than 37 weeks' gestation and non‐adjustment of myocardial time intervals for the difference in fetal heart rate. Additionally, our simple‐TGA data showed a decrease in PV/AV dimension ratio due to AV enlargement that can be indicative of vessel size alterations as a consequence of embryologic pathogenesis 50 , and also reflects flow‐mediated vascular remodeling due to adverse hemodynamic loading conditions 14,16,51 .…”

“…He suggested that pulmonary artery oxygen saturation in fetal TGA is increased to more than 70%, compared with 55% in normal fetuses (Figure 5). Both the fetal pulmonary circulation and ductus arteriosus become increasingly sensitive to the high oxygen content towards the end of gestation 18,36 , which may predispose to restriction of the FO and ductus arteriosus at term [4][5][6][7][8] and blood flow redistribution 7,[13][14][15][16] . Rudolph also proposed that blood flow to the right ventricle would have a low oxygen content, such that the saturation in the ascending aorta and cerebrovascular circulation would be as much as 20% lower than that in normal fetuses 5 (Figure 5).…”

“…In spite of modern cardiac technologies, such as tissue-Doppler and speckle-tracking echocardiography (STE), which have demonstrated better sensitivity for the detection of subtle subclinical changes in myocardial contractility in fetuses 20,21 , there is a paucity of data on the cardiac functional assessment of term fetuses with simple TGA, due to the lack of studies performed at the critical period near term, and with the published literature being limited by retrospective study design and application of only conventional echocardiographic techniques, with inconsistent findings 8,10,[13][14][15][16] . Some data are available on the evaluation of neonatal cardiac geometry and function in simple TGA 16,[22][23][24][25] , but results are conflicting, with only three of these studies using modern ultrasound modalities. Prediction of urgent BAS intervention after birth has not been elucidated fully and has relied on fetal cardiac measurements from retrospective studies that produced conflicting reports [4][5][6][7][8][9][10]12 .…”

Reference ranges for fetal cardiac, ventricular and atrial relative size, sphericity, ventricular dominance, wall asymmetry and relative wall thickness from 18 to 41 gestational weeks

“…Following technical advances, the role of fetal echocardiography, originally focused primarily on the diagnosis of congenital heart defects (CHD) 1 , has been extended to the evaluation of fetal cardiac remodeling, which is defined as a change in the size, shape and function of the heart in response to an insult 2 . Fetal cardiac remodeling is present in CHD [3][4][5][6] and other prenatal conditions, such as conception by assisted reproductive techniques (ART) 7 , fetal growth restriction (FGR) 8 , maternal diabetes 9 and drug exposure 10 . Accurate measurement of fetal cardiac, ventricular and atrial size and geometry is essential to assess the patterns of cardiac remodeling 11 and help understand and monitor fetal cardiac adaptations to an adverse environment.…”