New method to predict need for Rashkind procedure in fetuses with dextro‐transposition of the great arteries

• DOI: 10.1002/uog.17469
• Publication Date: 2017-03-14T20:59:45Z
• Authors: M. Słodki; R. Axt‐Fliedner; K. Zych‐Krekora; A. Wolter; A. Kawecki; C. Enzensberger; E. Gulczyńska; M. Respondek‐Libe...
• Keywords: Ductus venosus; Fetal echocardiography

Abstract Objective Prenatal congenital heart disease classification systems distinguish between critical dextro‐transposition of the great arteries (d‐TGA) with restriction foramen ovale (FO) (which requires a Rashkind procedure within first 24 h following delivery) and d‐TGA for which surgery is planned (after prostaglandin perfusion or later than after delivery). However, current prenatal diagnostic criteria postnatal FO in are inadequate, resulting high false‐negative rate. We aimed to identify echocardiographic features predict urgent need procedure. Methods identified retrospectively 98 patients singleton pregnancy diagnosed prenatally fetal at two European centers from 2006 2013. Two groups were compared: (1) those whom was performed postnatally; (2) who did not undergo before cardiac surgery. Exclusion were: no echocardiography 3 weeks prior delivery ( n = 18); 37 gestation 6); (3) improper lack measurement pulmonary vein maximum flow velocity 10); (4) neonatal follow‐up data 9); (5) more 4). Results Fifty‐one met inclusion criteria: 29 underwent 22 not. There differences these study terms maternal age, gestational age time echocardiography, biometric measurements, estimated weight, rate Cesarean delivery, newborn weight Apgar score 1 min. also during life size (heart area/chest area ratio), disproportion left right ventricle, diameter through FO. significantly higher group requiring (47.62 ± 7.48 vs 32.21 5.47 cm/s; P < 0.001). The cut‐off value 41 cm/s provided specificity (100%) positive predictive only slight cost sensitivity (82%) NPV (86%). appearance differed groups, valve being flat 52% Conclusions In fetuses d‐TGA, sonographic findings increased venous blood flattened associated could be used delivery. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.