title: Prenatal detection of transposition of the great arteries reduces mortality and morbidity.
abstract: OBJECTIVE
  To evaluate the prenatal detection of transposition of the great arteries (TGA), after the introduction of a Dutch screening program in 2007, as well as the effect of prenatal detection on pre- and postsurgical mortality and morbidity.
  
  
  METHODS
  In a geographical cohort study, all infants with TGA who were born between 1 January 2002 and 1 January 2012 were included. The cases were divided into two groups: those with and those without a prenatal diagnosis. Pre- and postsurgical mortality was assessed, with a follow-up of 1 year. Presurgical morbidity was assessed in terms of cardiovascular compromise, metabolic acidosis, renal and/or hepatic dysfunction and closure of the duct before initiation of therapy.
  
  
  RESULTS
  Of all cases (n = 144), 26.4% were diagnosed prenatally, with detection rates of 15.7% and 41.0% in the first and last 5 years of the study period, respectively. First-year mortality was significantly lower in cases with a prenatal diagnosis of TGA than in those without (0.0% vs 11.4%, respectively). Presurgical mortality (4.9%) only occurred in undetected simple TGA cases. Closure of the duct before treatment, renal dysfunction and hypoxia occurred significantly more often in the group without a prenatal diagnosis.
  
  
  CONCLUSIONS
  The prenatal detection rate of TGA has increased significantly since the introduction of the screening program in 2007. Prenatal diagnosis is an important factor that contributes to survival of the infant in the first postnatal year. Furthermore, some morbidity indicators were significantly higher in the group without a prenatal diagnosis. These results justify efforts to improve prenatal screening programs.
authors.affiliation: Department of Obstetrics and Gynecology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: C L
authors.initials: CL
authors.lastname: van Velzen
authors.forename: M C
authors.initials: MC
authors.lastname: Haak
authors.forename: G
authors.initials: G
authors.lastname: Reijnders
authors.forename: M E B
authors.initials: ME
authors.lastname: Rijlaarsdam
authors.forename: C J
authors.initials: CJ
authors.lastname: Bax
authors.forename: E
authors.initials: E
authors.lastname: Pajkrt
authors.forename: J
authors.initials: J
authors.lastname: Hruda
authors.forename: F
authors.initials: F
authors.lastname: Galindo-Garre
authors.forename: C M
authors.initials: CM
authors.lastname: Bilardo
authors.forename: C J M
authors.initials: CJ
authors.lastname: de Groot
authors.forename: N A
authors.initials: NA
authors.lastname: Blom
authors.forename: S A
authors.initials: SA
authors.lastname: Clur
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D008297:Male; D008403:Mass Screening; D009426:Netherlands / Q000453:epidemiology; D011247:Pregnancy; D014188:Transposition of Great Vessels / Q000000981:diagnostic imaging* / Q000196:embryology / Q000401:mortality; D016216:Ultrasonography, Prenatal
keywords: fetal echocardiography; morbidity; mortality; prenatal diagnosis; transposition of the great arteries