Prenatal risk factors for urgent atrial septostomy at birth in fetuses with transposition of the great arteries: a systematic review and meta-analysis

Prenatal sonography of the foramen ovale predicts urgent balloon atrial septostomy in neonates with complete transposition of the great arteries

“…From stored images and video clips, the echocardiographic findings listed in Table 1 and summarized in Figure 1 were obtained as previously described. 1 In our center, fetuses diagnosed as having dTGA are delivered regardless of the ultrasound features according to obstetrical indications, but to favor prompt treatment in the Cardiology Unit, patients who are candidate of vaginal delivery undergo elective induction of labor at term gestation. All the neonates are immediately evaluated at birth by a neonatologist and admitted into the Pediatric Cardiology Unit, where they are treated according to their clinical status.…”

“…Our results are in line with previous publications. 1,3 The correlation between the size of the FO and the need for urgent BAS has been previously described. Vigneswaran and associates 4 reported that the measurement was significantly smaller in cases requiring an urgent BAS.…”

“…C omplete dextro-transposition of the great arteries (dTGA) accounts for 5% to 7% of all congenital heart diseases and is one of the most common cyanotic congenital cardiac malformations. 1 During fetal life, dTGA is well tolerated because the 2 circulations communicate through the foramen ovale (FO) and ductus arteriosus. In the first days after birth, these communications are closed, leading to the development of severe hypoxemia and rapid hemodynamic deterioration.…”

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

“…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.…”

“…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 . Comprehensive evaluation of perinatal cardiac changes in term TGA fetuses using both conventional and modern ultrasound modalities may help in better understanding the pathophysiology of this congenital heart malformation, while prenatal prediction of the need for an urgent BAS after birth may help in optimizing perinatal management and pregnancy outcome and reducing the risks of postnatal cardiovascular complications.…”