Department of Cardiovascular Pediatrics, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, P.R. China.
Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, P.R. China.
Ital J Pediatr. 2024 Aug 22;50(1):153. doi: 10.1186/s13052-024-01730-w.
Transposition of the great arteries (TGA) is the most common cyanotic congenital heart defect in neonates but with low prenatal detection rate. This study sought to review the prenatal diagnosis, associated abnormalities, and mid-term postnatal outcomes of fetuses with TGA and investigate the integrated prenatal and postnatal management for TGA neonates.
A total of 134 infants prenatally diagnosed with TGA in Guangdong Provincial People's Hospital, China, from January 2009 to December 2022 were included in the study. The prenatal ultrasound data and neonatal records were reviewed to assess the accuracy of prenatal diagnosis. Univariate and multivariate logistic and Cox analyses were used to identify risk factors associated with prognosis in such individuals.
The population originated from 40 cities in 10 provinces in China, with integrated antenatal and postnatal management rate reaching 94.0% (126/134) and a high accuracy rate (99.3%) of prenatal primary diagnosis. The median period of follow-up was 1.6 [interquartile range (IQR) 0.1-4.3] years. There were 3 (2.2%) postnatal deaths, 118 (88.1%) patients undergoing arterial switch operation (ASO), 3 (2.2%) undergoing Rastelli operations and 5 (3.7%) doing stage operations. Of 118 patients receiving ASO, the major morbidity occurred in 64 patients (54.2%), and right ventricular outflow tract obstruction (RVOTO) in 31 (26.3%). In the multivariate logistic analysis, gestational ages at birth (OR = 0.953, 95% CI 0.910-0.991; p = 0.025) and cardiopulmonary bypass (CPB) time (OR = 1.010, 95% CI 1.000-1.030; p = 0.038) were identified as independent risk factors associated with major morbidity. In the Cox multivariate analysis, aortic cross-clamping time (HR = 1.030, 95% CI 1.000-1.050; p = 0.017) was identified as independent risk factor associated with RVOTO.
Earlier gestational ages at birth and longer CPB time are significantly associated with increased morbidity. Integrated prenatal and postnatal management is recommended for patients with prenatal diagnosis of TGA.
大动脉转位（TGA）是新生儿中最常见的发绀型先天性心脏病，但产前检出率较低。本研究旨在回顾 TGA 胎儿的产前诊断、相关异常及中期产后结局，并探讨 TGA 新生儿的产前-产后综合管理。
本研究纳入 2009 年 1 月至 2022 年 12 月在广东省人民医院产前诊断为 TGA 的 134 例婴儿。回顾分析产前超声资料和新生儿病历，评估产前诊断的准确性。采用单因素和多因素逻辑回归及 Cox 分析，识别与预后相关的危险因素。
该人群来自中国 10 个省 40 个城市，产前-产后综合管理率达 94.0%（126/134），产前初步诊断准确率高（99.3%）。中位随访时间为 1.6 年[四分位间距（IQR）0.1-4.3]。有 3 例（2.2%）新生儿死亡，118 例行大动脉调转术（ASO），3 例行 Rastelli 手术，5 例行分期手术。行 ASO 的 118 例患者中，64 例（54.2%）发生主要并发症，31 例（26.3%）发生右心室流出道梗阻（RVOTO）。多因素逻辑回归分析显示，出生时胎龄（OR=0.953，95%CI 0.910-0.991；p=0.025）和体外循环（CPB）时间（OR=1.010，95%CI 1.000-1.030；p=0.038）是发生主要并发症的独立危险因素。Cox 多因素分析显示，主动脉阻断时间（HR=1.030，95%CI 1.000-1.050；p=0.017）是发生 RVOTO 的独立危险因素。
出生时胎龄越小、CPB 时间越长，与发病率增加显著相关。建议对产前诊断为 TGA 的患者进行产前-产后综合管理。
