AEPC-YIA 選別講演（I-YIA）

[I-YIA-01] Longitudinal Hemodynamic Assessment of Fetuses with TGA to Predict The Perinatal Course – The Pilot Study

^○Agnieszka Grzyb^1,3, Adam Kolesnik^2,3, Joanna Duliban³, Monika Kowalczyk-Domagala¹, Maria Zubrzycka², Grazyna Brzezinska-Rajszys^1,2, Renata Bokiniec⁴, Joanna Dangel³ (1.Cardiology Department, The Children's Memorial Health Institute, Warsaw, Poland, 2.Heart Catheterization Laboratory, The Children's Memorial Health Institute, Warsaw, Poland, 3.Perinatal Cardiology and Congenital Anomalies Department, Centre of Postgraduate Medical Education, Warsaw, Poland, 4.Neonatology and Neonatal Intensive Care Department, Medical University of Warsaw, Warsaw, Poland)

Transposition of the great arteries (TGA) is one of the most common congenital heart diseases, well-tolerated prenatally, however life-threatening for the newborn. The main concerns are: the foramen ovale (FO) restriction and persistent pulmonary hypertension (PPHN).
The aim of this study is to predict the hemodynamic status of the newborn with TGA based on longitudinal prenatal echocardiographic observation.

Methods: Retrospective-prospective analysis of echocardiographic examinations of 70 fetuses with simple TGA.

Results: Based on our observations we developed a flowchart of fetal TGA assessment presented below. Its usefulness in predicting the newborn’s condition is shown in the table.

1. FO flow R→L or bidirectional:
a. blood mixing (Color Doppler) clearly visible→ NO RESTRICTION.
b. mixing limited by interatrial septum [IAS] → go to point 2/3.
2. Short, thickened, usually hypermobile FO valve, R→L unrestrictive DA flow, systolic velocity PT=Ao or PT>Ao→ FO RESTRICTION.
3. Long FO valve bulging deeply into the left atrium:
a. DA L→R diastolic flow, systolic velocity PTb. If in subsequent examinations the atrial septum excursion decreases or septum becomes hypermobile; end-systolic and/or diastolic L→R DA flow→ increased pulmonary flow→ RISK OF PPHN.
4. DA restriction/narrowing OR long lasting (≥5 weeks) limited interatrial mixing→ HIGH RISK OF PPHN.
5. Obligatory assessment every 1-2 week after 35 week of pregnancy.



Conclusions: Longitudinal assessment of fetal TGA hemodynamics seems to predict the newborn’s condition with high accuracy and specificity, which is important in planning the perinatal period, especially in cases with suspected PPHN.