title: Relationship between interatrial communication, ductus arteriosus, and pulmonary flow patterns in fetuses with transposition of the great arteries: prediction of neonatal desaturation.
abstract: BACKGROUND
  The relationship between interatrial communication, ductus arteriosus, and pulmonary flow in transposition of the great arteries and intact ventricular septum may help predict postnatal desaturation.
  
  
  METHODS
  Echocardiographic data of 45 fetuses with transposition of the great arteries and intact ventricular septum and 50 age-matched controls were retrospectively reviewed. Interatrial communication, left and right ventricular output, flow in the ductus arteriosus, as well as effective pulmonary flow were measured. Patients were divided into two groups on the basis of postnatal saturations: group 1 had saturations ⩽50% and group 2 >50%.
  
  
  RESULTS
  Of 45 fetuses, 13 (26.7%) were classified into group 1. Compared with fetuses in group 2, they had a smaller interatrial communication (2.9 versus 4.0 mm, p=0.004) and more retrograde diastolic flow in the ductus arteriosus (92 versus 23%, p=0.002). Both groups showed a significant decrease in ductal flow compared with controls. Patients in group 2 had a higher effective pulmonary flow compared with controls. There was a mild correlation between left ventricular output and size of the interatrial communication (Spearman's rank correlation 0.44).
  
  
  CONCLUSIONS
  A retrograde diastolic flow is present in most of the fetuses with postnatal desaturation. Fetuses with transposition of the great arteries have a lower flow through the ductus arteriosus compared with controls. Fetuses without restrictive foramen ovale have higher effective pulmonary flow. Peripheral pulmonary vasodilatation due to higher oxygen saturation in pulmonary arteries in the case of transposition of the great arteries could be one possible cause.
authors.affiliation: 1Department of Paediatrics,Division of Paediatric Cardiology,Sainte-Justine University Hospital Center,Montréal,Québec,Canada.
authors.forename: Laurence
authors.initials: L
authors.lastname: Vaujois
authors.affiliation: 3Division of Obstetrics and Gynecology,Sainte-Justine University Hospital Center,Montréal,Québec,Canada.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Boucoiran
authors.affiliation: 4Research Center,Sainte-Justine University Hospital Center,Montréal,Québec,Canada.
authors.forename: Christophe
authors.initials: C
authors.lastname: Preuss
authors.affiliation: 1Department of Paediatrics,Division of Paediatric Cardiology,Sainte-Justine University Hospital Center,Montréal,Québec,Canada.
authors.forename: Myriam
authors.initials: M
authors.lastname: Brassard
authors.affiliation: 2Department of Paediatrics,Division of Paediatric Cardiology,Laval University,Québec City,Canada.
authors.forename: Christine
authors.initials: C
authors.lastname: Houde
authors.affiliation: 1Department of Paediatrics,Division of Paediatric Cardiology,Sainte-Justine University Hospital Center,Montréal,Québec,Canada.
authors.forename: Jean C
authors.initials: JC
authors.lastname: Fouron
authors.affiliation: 1Department of Paediatrics,Division of Paediatric Cardiology,Sainte-Justine University Hospital Center,Montréal,Québec,Canada.
authors.forename: Marie-Josée
authors.initials: MJ
authors.lastname: Raboisson
mesh_terms: D016022:Case-Control Studies; D004373:Ductus Arteriosus / Q000002:abnormalities* / Q000000981:diagnostic imaging; D018618:Echocardiography, Doppler, Color; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000000981:diagnostic imaging*; D006352:Heart Ventricles / Q000503:physiopathology*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011247:Pregnancy; D011651:Pulmonary Artery / Q000002:abnormalities* / Q000000981:diagnostic imaging; D012189:Retrospective Studies; D014188:Transposition of Great Vessels / Q000150:complications / Q000000981:diagnostic imaging*; D016216:Ultrasonography, Prenatal
keywords: Transposition of the great arteries; fetal circulation; neonatal hypoxia; prenatal ductal flow; restrictive foramen ovale