Escobar-Diaz M C, Freud L R, Bueno A, Brown D W, Friedman K G, Schidlow D, Emani S, Del Nido P J, Tworetzky W
Department of Cardiology, Boston Children's Hospital, Boston, MA, USA.
Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
Ultrasound Obstet Gynecol. 2015 Jun;45(6):678-82. doi: 10.1002/uog.14751. Epub 2015 Apr 30.
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.
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.
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).
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.
评估室间隔完整的大动脉转位（TGA/IVS）产前诊断的时间趋势及其对新生儿发病率和死亡率的影响。
本研究队列纳入了在20年期间（1992 - 2011年）因TGA/IVS转诊至本中心接受手术治疗的新生儿。研究期分为五个4年时间段，主要结局是产前诊断率。次要结局包括新生儿术前状况和围手术期生存率。
在340例TGA/IVS患者中，81例（23.8%）有产前诊断。产前诊断率在研究期间有所上升，从1992 - 1995年的6%升至2008 - 2011年的41%（P < 0.001）。与产后诊断的患者相比，产前诊断的患者球囊房间隔造口术（BAS）实施时间更早（分别为出生后0天和1天；P < 0.001），且产前诊断的新生儿需要机械通气的较少（55.6%对68.0%；P = 0.03）。在产前或产后诊断为TGA/IVS的患者之间，术前酸中毒发生率（16.0%对25.5%；P = 0.1）、术前体外膜肺氧合需求（2.5%对2.7%；P = 1.0）或死亡率（产前诊断患者术前1例死亡，术后无死亡；产后诊断患者术前4例死亡，术后6例死亡）无统计学显著差异。
TGA/IVS的产前检出率有所提高，但仍低于50%，提示需要采取提高检出率的策略。产前和产后诊断的患者死亡率无统计学显著差异，然而，在早期BAS和较少需要机械通气的新生儿方面存在显著的术前差异。需要持续开展工作以确定产前诊断是否具有长期益处。
