Abstract
Background
Transposition of the great arteries (TGA) may present as a life-threatening neonatal
malformation. Although prenatal detection facilitates the perinatal management, the
impact on outcome is controversial.
Methods
This study reviewed the differences in prenatal diagnosis of TGA from 2009 to 2014
among the 5 geographic areas in Ontario and compared the management, morbidity, and
mortality among neonates with a prenatal (prenatal cohort; n = 70) vs a postnatal
(postnatal cohort; n = 76) anomaly diagnosis. Cases were identified from prospective
databases of the provincial cardiac tertiary centres and the coroner’s office.
Results
Prenatal TGA detection rates varied significantly among areas (median: 50%; range:
14% to 72%; P = 0.03). Compared with the postnatal cohort, time from birth to tertiary care admission
(1.4 vs 10.4 hours, P < 0.001), prostaglandin therapy (0.1 vs 5.3 hours; P < 0.001), balloon atrial septostomy (5.3 vs 14.9 hours; P <0.001), and arterial switch operation (6 vs 9 days, P = 0.002) was significantly shorter in the prenatal cohort. Although other preoperative
variables—including the need of ventilation and mechanical support, morbidity score,
and lowest pH and preductal oxygen saturations—were comparable, a prenatal diagnosis
was associated with improved 1-year survival (odds ratio: 0.108; 95% confidence interval,
0.013-0.88; P = 0.0184).
Conclusions
Prenatal diagnosis of TGA significantly shortened time intervals from birth to neonatal
care and surgery and was associated with improved survival. The prenatal detection
rate of TGA in Ontario was low (50% or less) outside of Metropolitan Toronto, suggesting
the need for new strategies to further improve intraprovincial detection rates.
Résumé
Contexte
La transposition des grosses artères (TGA) est une malformation néonatale potentiellement
mortelle. Même si sa détection avant la naissance peut faciliter la prise en charge
périnatale, son incidence sur l’issue ne fait pas l’unanimité.
Méthodologie
Les auteurs ont examiné les différences entre les diagnostics périnataux de TGA posés
entre 2009 et 2014 dans cinq régions de l’Ontario et comparé la prise en charge, la
morbidité et la mortalité des nouveau-nés chez qui l’anomalie a été diagnostiquée
avant la naissance (cohorte prénatale; n = 70) ou après la naissance (cohorte postnatale;
n = 76). Les cas relevés proviennent des bases de données prospectives des centres
de soins tertiaires en cardiologie provinciaux et du Bureau du coroner.
Résultats
Les taux de détection de la TGA avant la naissance varient sensiblement d’une région
à l’autre (médiane : 50 %; plage : 14 à 72 %; p = 0,03). Le temps écoulé entre la naissance et l’admission dans un centre de soins
tertiaires (1,4 vs 10,4 heures, p < 0,001), l’instauration d’un traitement par une prostaglandine (0,1 vs 5,3 heures;
p < 0,001), la septostomie auriculaire par ballonnet (5,3 vs 14,9 heures; p < 0,001) et l’intervention de détransposition artérielle (6 vs 9 jours, p = 0,002) était significativement plus court dans la cohorte prénatale que dans la
cohorte postnatale. Même si d’autres variables préopératoires étaient comparables,
notamment le besoin d’une ventilation artificielle et d’une assistance mécanique,
le score de morbidité et les valeurs les plus faibles du pH et de la saturation en
oxygène préductale, le diagnostic prénatal a été associé à une meilleure survie à
1 an (rapport de cotes : 0,108; intervalle de confiance à 95 %, 0,013-0,88; p = 0,0184).
Conclusions
Le diagnostic prénatal de TGA a significativement réduit le temps écoulé entre la
naissance et les soins néonataux et la chirurgie, et a été associé à une meilleure
survie. En Ontario, les taux de détection prénatale de la TGA étaient faibles (50
% ou moins) en dehors de Toronto Métropolitain, ce qui semble indiquer que de nouvelles
stratégies s’imposent afin d’améliorer les taux de détection dans la province.
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References
- The incidence of congenital heart disease.J Am Coll Cardiol. 2002; 39: 1890-1900
- Cardiac outcomes in young adult survivors of the arterial switch operation for transposition of the great arteries.J Am Coll Cardiol. 2010; 56: 58-64
- Long-term outcome and quality of life after arterial switch operation: a prospective study with a historical comparison.Congenit Heart Dis. 2013; 8: 203-210
- Detection of transposition of the great arteries in fetuses reduces neonatal morbidity and mortality.Circulation. 1999; 99: 916-918
- Prenatal detection of transposition of the great arteries reduces mortality and morbidity.Ultrasound Obstet Gynecol. 2015; 45: 320-325
- Outcomes when congenital heart disease is diagnosed antenatally versus postnatally in the UK: a retrospective population-based study.BMC Pediatr. 2015; 15: 58
- Prenatal diagnosis of transposition of the great arteries over a 20-year period: improved but imperfect.Ultrasound Obstet Gynecol. 2015; 45: 678-682
- Impact of prenatal diagnosis on the outcome of patients with a transposition of great arteries: a 24-year population-based study.Birth Defects Res A Clin Mol Teratol. 2016; 106: 178-184
- Impact of prenatal diagnosis on survival of newborns with four congenital heart defects: a prospective, population-based cohort study in France (the EPICARD Study).BMJ Open. 2017; 7e018285
- Impact of prenatal diagnosis of transposition of the great arteries on postnatal outcome.J Matern Fetal Neonatal Med. 2017; 30: 2858-2863
- ISUOG consensus statement: what constitutes a fetal echocardiogram?.Ultrasound Obstet Gynecol. 2008; 32: 239-242
- ISUOG Practice Guidelines (updated): sonographic screening examination of the fetal heart.Ultrasound Obstet Gynecol. 2013; 41: 348-359
- Diagnostic Imaging Committee. Content of a complete routine second trimester obstetrical ultrasound examination and report.J Obstet Gynaecol Can. 2009; 31: 272-275
- AIUM practice guideline for the performance of obstetric ultrasound examinations.J Ultrasound Med. 2010; 29: 157-166
- Comparative analysis of pattern, management and outcome of pre- versus postnatally diagnosed major congenital heart disease: a population-based study.Ultrasound Obstet Gynecol. 2001; 17: 380-385
- Impact of prenatal diagnosis of transposition of the great arteries on obstetric and early postnatal management.Eur J Obstet Gynecol Reprod Biol. 2009; 142: 18-22
- The hidden mortality of transposition of the great arteries and survival advantage provided by prenatal diagnosis.BJOG. 2008; 115: 1096-1100
- Prenatal ultrasound screening of congenital heart disease in an unselected national population: a 21-year experience.Heart. 2011; 97: 124-130
- Prenatal screening for major congenital heart disease: assessing performance by combining national cardiac audit with maternity data.Heart. 2014; 100: 375-382
- Disparities in the prenatal detection of critical congenital heart disease.Prenat Diagn. 2015; 35: 859-863
- Birth before 39 weeks' gestation is associated with worse outcomes in neonates with heart disease.Pediatrics. 2010; 126: 277-284
- Population trends in prenatal detection of transposition of great arteries: impact of obstetric screening ultrasound guidelines.Ultrasound Obstet Gynecol. 2018; 51: 659-664
- Where we live: health care in rural vs urban America.JAMA. 2002; 287: 108
- Characteristics of indigenous primary health care service delivery models: a systematic scoping review.Global Health. 2018; 14: 12
Article info
Publication history
Published online: January 20, 2020
Accepted:
January 13,
2020
Received:
October 7,
2019
Footnotes
See editorial by Young and Sinclair, pages 1564—1565 of this issue.
The authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
See page 1597 for disclosure information.
Identification
Copyright
© 2020 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
ScienceDirect
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- The Critical Importance of Prenatal Diagnosis of Critical Congenital Heart Disease: Toward 100% Detection in All RegionsCanadian Journal of CardiologyVol. 36Issue 10
- PreviewCongenital heart disease (CHD) is the most common congenital lesion, found in 1% of live births.1 Of this population, critical CHD (CCHD) is found in 25%, requiring early intervention to optimize outcomes. CCHD can be diagnosed postnatally on initial examination, through pulse oximetry screening, when neonates present in cardiogenic shock, or on autopsy. Death from unrecognized CCHD accounted for 4.6 of 10,000 live births in Sweden between 2004 and 2007.2 Prenatally, ultrasound can diagnose CCHD, with initial publications of in utero detection of heart disease, dating from 1980.
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