Vigneswaran Trisha V, Zidere Vita, Miller Owen I, Simpson John M, Sharland Gurleen K
Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom.
Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom.
Am J Cardiol. 2017 May 1;119(9):1463-1467. doi: 10.1016/j.amjcard.2017.01.017. Epub 2017 Feb 9.
The outcome of the arterial switch operation for transposition of the great arteries (TGA) is excellent, but there is still associated preoperative mortality. Hypoxemia due to inadequate mixing of the pulmonary and systemic circulations may be implicated. Prediction of early hypoxemia by prenatal echocardiographic criteria has proved difficult. We aimed to identify prenatal echocardiographic features that may predict the need for emergency balloon atrial septostomy (BAS) in isolated TGA. Third trimester fetal echocardiograms of the last 40 cases of isolated TGA were reviewed without knowledge of the postnatal outcome. Measurements of the arterial valves, arterial duct, total septal length (TSL), and foramen ovale (FO) length were made, in addition to a subjective assessment of the atrial septum. The first postnatal echocardiogram and charts were reviewed. Comparison with 40 gestation-matched control fetuses was performed. The FO length in normal fetuses was not significantly different from those with TGA who did not require an emergency BAS but was significantly smaller in fetuses with TGA who required an emergency BAS (p = 0.01). An emergency BAS was required in 12 of 40 cases. All 3 cases with limited movement of the atrial septum required emergency BAS. A hypermobile atrial septum was observed in 10 cases and was not associated with emergency BAS (p = 0.8). The FO:TSL was significantly smaller in those who required an emergency BAS with good predictive value (area under the receiver operating characteristics curve: 0.80). The sensitivity for FO:TSL <0.5 was 99%. There was no significant difference in arterial duct, pulmonary valve, or branch pulmonary artery diameters between those cases requiring emergency BAS and those who did not. In conclusion, the likelihood of an emergency BAS is increased by FO:TSL <0.5 and a fixed appearance of the flap valve. Hypermobile and/or aneurysmal atrial septum did not indicate inadequate postnatal mixing in our group.
大动脉转位（TGA）动脉调转术的预后良好，但术前仍存在相关死亡率。可能与肺循环和体循环混合不充分导致的低氧血症有关。事实证明，通过产前超声心动图标准预测早期低氧血症很困难。我们旨在确定产前超声心动图特征，这些特征可能预测孤立性TGA患者是否需要紧急球囊房间隔造口术（BAS）。回顾了最近40例孤立性TGA病例的孕晚期胎儿超声心动图，且不知晓产后结局。除了对房间隔进行主观评估外，还测量了动脉瓣、动脉导管、总间隔长度（TSL）和卵圆孔（FO）长度。回顾了产后首次超声心动图和病历。与40例孕周匹配的对照胎儿进行了比较。正常胎儿的FO长度与不需要紧急BAS的TGA胎儿无显著差异，但需要紧急BAS的TGA胎儿的FO长度明显更小（p = 0.01）。40例中有12例需要紧急BAS。房间隔活动受限的所有3例均需要紧急BAS。观察到10例房间隔活动过度，与紧急BAS无关（p = 0.8）。需要紧急BAS的患者中，FO:TSL明显更小，具有良好的预测价值（受试者工作特征曲线下面积：0.80）。FO:TSL<0.5的敏感性为99%。需要紧急BAS的病例与不需要的病例之间，动脉导管、肺动脉瓣或分支肺动脉直径无显著差异。总之，FO:TSL<0.5和瓣叶固定外观会增加紧急BAS的可能性。在我们的研究组中，房间隔活动过度和/或动脉瘤样房间隔并不表明产后混合不充分。
