Sensitivity and specificity of prenatal features of physiological shunts to predict neonatal clinical status in transposition of the great arteries.
BACKGROUND
Although prenatal diagnosis of transposition of the great arteries (TGA) reduces neonatal mortality, the preoperative course can be complicated in infants with a restrictive foramen ovale (FO) or a ductus arteriosus (DA) constriction. We sought to determine the specificity and sensitivity of prenatal features of physiological shunts in predicting postnatal clinical status in prenatally diagnosed TGA in babies delivered in a tertiary care center providing all facilities for neonatal urgent care.


RESULTS
The outcomes of 130 fetuses with TGA were reviewed over a period of 5.5 years. Restriction of the FO and/or constriction of the DA could be analyzed in 119/130 fetuses at 36+/-2.7 weeks of gestation. Twenty-four out of 119 had at least 1 abnormal shunt (23 FO, 5 DA, and 4 both). Thirteen of 130 neonates had profound hypoxemia (PaO2<25 mm Hg) and metabolic acidosis (pH <7.15) in the first 30 minutes and required immediate balloon atrioseptostomy. Two who had abnormal FO and DA died despite aggressive resuscitation. The specificity and sensitivity of the fetal echo in predicting neonatal emergency were 84% and 54%, respectively. The specificity and sensitivity of a combination of restrictive FO and DA constriction were 100% and 31%, respectively.


CONCLUSIONS
Restriction of the FO and/or of the DA has a high specificity to predict the need for emergency neonatal care in fetuses with TGA, but the sensitivity is too low to detect all high-risk fetuses. Exceptional procedures should be considered for fetuses that have a combination of restrictive FO and DA constriction.
Jouannic
Jean-Marie
JM
Maternité, Hôpital Necker Enfants Malades, Paris, France.
Gavard
Laurent
L
Fermont
Laurent
L
Le Bidois
Jérôme
J
Parat
Sophie
S
Vouhé
Pascal R
PR
Dumez
Yves
Y
Sidi
Daniel
D
Bonnet
Damien
D
D000015:Abnormalities, Multiple / Q000473:pathology / Q000601:surgery; D000527:Alprostadil / Q000627:therapeutic use; D000800:Angioplasty, Balloon; D019090:Case Management; D003131:Combined Modality Therapy; D004373:Ductus Arteriosus / Q000000981:diagnostic imaging* / Q000196:embryology / Q000473:pathology; D005260:Female; D005318:Fetal Heart / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000473:pathology; D005865:Gestational Age; D006330:Heart Defects, Congenital / Q000473:pathology / Q000601:surgery; D006346:Heart Septum / Q000000981:diagnostic imaging* / Q000196:embryology / Q000473:pathology; D017052:Hospital Mortality; D006801:Humans; D000860:Hypoxia / Q000151:congenital; D007231:Infant, Newborn; D008297:Male; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014188:Transposition of Great Vessels / Q000000981:diagnostic imaging* / Q000196:embryology / Q000401:mortality / Q000601:surgery; D016896:Treatment Outcome; D016216:Ultrasonography, Prenatal
D000527:Alprostadil