title: Prenatal diagnosis of transposition of the great arteries over a 20-year period: improved but imperfect.
abstract: OBJECTIVE
  To evaluate temporal trends in the prenatal diagnosis of transposition of the great arteries with intact ventricular septum (TGA/IVS) and its impact on neonatal morbidity and mortality.
  
  
  METHODS
  We included in this study cohort newborns with TGA/IVS who were referred for surgical management to our center over a 20-year period (1992-2011). The study period was divided into five 4-year periods and the primary outcome was rate of prenatal diagnosis. Secondary outcomes included neonatal preoperative status and perioperative survival.
  
  
  RESULTS
  Of the 340 patients with TGA/IVS, 81 (23.8%) had a prenatal diagnosis. The rate of prenatal diagnosis increased over the study period, from 6% in 1992-1995 to 41% in 2008-2011 (P < 0.001). Compared to patients with a postnatal diagnosis, balloon atrial septostomy (BAS) was performed earlier in patients with a prenatal diagnosis (0 days after delivery vs 1 day after delivery, respectively; P < 0.001) and fewer prenatally diagnosed neonates required mechanical ventilation (55.6% vs 68.0%; P = 0.03). Between patients with a prenatal or postnatal diagnosis of TGA/IVS, there were no statistically significant differences in the incidence of preoperative acidosis (16.0% vs 25.5%; P = 0.1), need for preoperative extracorporeal membrane oxygenation (2.5% vs 2.7%; P = 1.0) or mortality (one preoperative and no postoperative deaths among prenatally diagnosed patients compared with four preoperative and six postoperative deaths among postnatally diagnosed patients).
  
  
  CONCLUSIONS
  The prenatal detection rate of TGA/IVS has improved but still remains below 50%, suggesting the need for strategies to increase detection rates. The mortality rate was not statistically significantly different between prenatally and postnatally diagnosed patients, however, there were significant preoperative differences with regard to earlier BAS and fewer neonates that required mechanical ventilation. Ongoing work is required to ascertain whether prenatal diagnosis confers long-term benefits.
authors.affiliation: Department of Cardiology, Boston Children's Hospital, Boston, MA, USA.|Department of Pediatrics, Harvard Medical School, Boston, MA, USA.|Universidad Pontificia Bolivariana, Medellin, Colombia.
authors.forename: M C
authors.initials: MC
authors.lastname: Escobar-Diaz
authors.affiliation: Department of Cardiology, Boston Children's Hospital, Boston, MA, USA.|Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
authors.forename: L R
authors.initials: LR
authors.lastname: Freud
authors.affiliation: Department of Cardiology, Boston Children's Hospital, Boston, MA, USA.|Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
authors.forename: A
authors.initials: A
authors.lastname: Bueno
authors.affiliation: Department of Cardiology, Boston Children's Hospital, Boston, MA, USA.|Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
authors.forename: D W
authors.initials: DW
authors.lastname: Brown
authors.affiliation: Department of Cardiology, Boston Children's Hospital, Boston, MA, USA.|Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
authors.forename: K G
authors.initials: KG
authors.lastname: Friedman
authors.affiliation: Department of Cardiology, Boston Children's Hospital, Boston, MA, USA.|Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
authors.forename: D
authors.initials: D
authors.lastname: Schidlow
authors.affiliation: Department of Cardiac Surgery, Boston Children's Hospital, Boston, MA, USA.|Department of Surgery, Harvard Medical School, Boston, MA, USA.
authors.forename: S
authors.initials: S
authors.lastname: Emani
authors.affiliation: Department of Cardiac Surgery, Boston Children's Hospital, Boston, MA, USA.|Department of Surgery, Harvard Medical School, Boston, MA, USA.
authors.forename: P J
authors.initials: PJ
authors.lastname: Del Nido
authors.affiliation: Department of Cardiology, Boston Children's Hospital, Boston, MA, USA.|Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
authors.forename: W
authors.initials: W
authors.lastname: Tworetzky
mesh_terms: D000293:Adolescent; D000328:Adult; D006328:Cardiac Catheterization / Q000379:methods; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011247:Pregnancy; D012121:Respiration, Artificial; D012189:Retrospective Studies; D013997:Time Factors; D014188:Transposition of Great Vessels / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000628:therapy; D016216:Ultrasonography, Prenatal / Q000639:trends*; D055815:Young Adult
keywords: metabolic acidosis; outflow tract view; prenatal diagnosis; survival; transposition of the great arteries