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(Circulation. 2004;110:1743-1746.)
© 2004 American Heart Association, Inc.

Congenital Heart Disease

Sensitivity and Specificity of Prenatal Features of Physiological Shunts to Predict Neonatal Clinical Status in Transposition of the Great Arteries

Jean-Marie Jouannic, MD; Laurent Gavard, MD; Laurent Fermont, MD; Jérôme Le Bidois, MD; Sophie Parat, MD; Pascal R. Vouhé, MD; Yves Dumez, MD; Daniel Sidi, MD; Damien Bonnet, MD, PhD

From Maternité (J.-M.J., L.G., S.P., Y.D.) and Service de Cardiologie Pédiatrique (J.L.B., P.R.V., D.S., D.B.), Hôpital Necker-Enfants Malades, and the Institut de Puériculture (L.F.), Paris, France.

Correspondence to Damien Bonnet, Cardiologie Pédiatrique, Hôpital Necker Enfants Malades AP-HP, 149, rue de Sèvres 75743 Paris cedex 15, France, EU. E-mail damien.bonnet{at}nck.ap-hop-paris.fr

Received April 4, 2003; de novo received April 7, 2004; revision received May 17, 2004; accepted May 18, 2004.

Background— Although prenatal diagnosis of transposition of the great arteries (TGA) reduces neonatal mortality, the preoperative course can be complicated in infants with a restrictive foramen ovale (FO) or a ductus arteriosus (DA) constriction. We sought to determine the specificity and sensitivity of prenatal features of physiological shunts in predicting postnatal clinical status in prenatally diagnosed TGA in babies delivered in a tertiary care center providing all facilities for neonatal urgent care.

Methods and Results— The outcomes of 130 fetuses with TGA were reviewed over a period of 5.5 years. Restriction of the FO and/or constriction of the DA could be analyzed in 119/130 fetuses at 36±2.7 weeks of gestation. Twenty-four out of 119 had at least 1 abnormal shunt (23 FO, 5 DA, and 4 both). Thirteen of 130 neonates had profound hypoxemia (PaO₂<25 mm Hg) and metabolic acidosis (pH <7.15) in the first 30 minutes and required immediate balloon atrioseptostomy. Two who had abnormal FO and DA died despite aggressive resuscitation. The specificity and sensitivity of the fetal echo in predicting neonatal emergency were 84% and 54%, respectively. The specificity and sensitivity of a combination of restrictive FO and DA constriction were 100% and 31%, respectively.

Conclusions— Restriction of the FO and/or of the DA has a high specificity to predict the need for emergency neonatal care in fetuses with TGA, but the sensitivity is too low to detect all high-risk fetuses. Exceptional procedures should be considered for fetuses that have a combination of restrictive FO and DA constriction.

Key Words: heart defects, congenital • transposition of great vessels • echocardiography

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