D-Transposition of the great arteries with restrictive foramen ovale in the fetus: the dilemma of predicting the need for postnatal urgent balloon atrial septostomy

• DOI: 10.1007/s00404-023-06997-8
• Publication Date: 2023-03-27T07:03:03Z
• Authors: I. Gottschalk; A. Walter; T. Menzel; E. C. Weber; S. Wendt; N. Sreeram; U. Gembruch; C. Berg; J. S. Abel
• Keywords: Foramen ovale (heart); Ductus venosus; Fetal echocardiography

Abstract Objective Restrictive foramen ovale (FO) in dextro-transposition of the great arteries (d-TGA) with intact ventricular septum may lead to severe life-threatening hypoxia within first hours life, making urgent balloon atrial septostomy (BAS) inevitable. Reliable prenatal prediction restrictive FO is crucial these cases. However, current echocardiographic markers show low predictive value, and often fails fatal consequences for a subset newborns. In this study, we described our experience aimed identify reliable BAS. Methods We included 45 fetuses isolated d-TGA that were diagnosed delivered between 2010 2022 two large German tertiary referral centers. Inclusion criteria availability former ultrasound reports, stored videos still images, which had be obtained last 14 days prior delivery sufficient quality retrospective re-analysis. Cardiac parameters retrospectively assessed their value was evaluated. Results Among d-TGA, 22 neonates postnatally required BAS 24 h life. contrast, 23 normal anatomy, but 4 them unexpectedly showed inadequate interatrial mixing despite rapidly developed also (‘bad mixer’). Overall, 26 (58%) BAS, whereas 19 (42%) achieved good O 2 saturation did not undergo subsequent correctly predicted 11 cases (50% sensitivity), anatomy (83% specificity). After re-analysis identified three highly significant FO: diameter < 7 mm ( p 0.01), fixed = 0.035) hypermobile 0.014) flap. The maximum systolic flow velocities pulmonary veins significantly increased 0.021), no cut-off reliably predict could identified. If above are applied, all (100% positive value). Correct succeeded PPV), naturally failed mixer’) (82.6% negative Conclusion Precise assessment size flap motility allows both postnatally. Prediction likelihood succeeds FO, identification small requires fails, because ability postnatal cannot prenatally. Therefore, prenatally should always center cardiac catheter stand-by, allowing after birth, regardless anatomy.