Abstract 14453: Impact of Prenatal Diagnosis on Preoperative Neurological Morbidity in Neonates with Transposition of the Great Arteries
Introduction: Operative and long term survival in patients with transposition of the great arteries (TGA) is excellent in the current era. Survivors have quantifiable neurological morbidity at postoperative follow-up; the etiology of this process is unclear. We evaluated the incidence of and risk factors for preoperative neurological morbidity in this population.
Hypothesis: Patients with TGA who are prenatally diagnosed have reduced neurological morbidity compared with those who are diagnosed postnatally.
Methods: We retrospectively reviewed all admitted patients with a diagnosis of TGA between 2005- 2011. Patients with single ventricle physiology were excluded. The primary outcome was preoperative neurological morbidity (seizure and/or stroke); secondary outcome was mortality. Seizures were diagnosed clinically. Strokes were diagnosed based on clinical signs that correlated with MRI or CT findings. Univariable analyses were performed to evaluate risk factors related to the primary and secondary outcome measures. A p<0.05 was deemed significant.
Results: The study population consisted of 170 patients; 53(31%) were prenatally diagnosed. At hospital admission, patients had a median age of 21.9 hours, FiO2 of 0.3, minimum SPO2 of 73% and alprostadil dose of 50 ng/kg/min. Overall, use of preoperative balloon atrioseptostomy in this cohort was high (88%). Of the 169 who underwent operative repair, operative (<30 day) and 1 year survival was 98.2% and 97.0% respectively; one patient did not undergo operation. Preoperative seizure occurred in 10 (6%) patients and was significantly associated with: a diagnosis of TGA intact ventricular septum (10 of 100) vs. not (0 of 70; p=0.029) and postnatal diagnosis (10 of 117) vs. prenatal diagnoses (0 of 53; p=0.032). Preoperative stroke occurred in 9 (5.3%) and tended to be associated with postnatal (9 of 117) vs. prenatal diagnosis (0 of 52; p=0.058).
Conclusion: The most significant modifiable association with preoperative neurological morbidity in patients TGA is timing of diagnosis. The low prenatal detection rate described in our study is in keeping with previously reported data. Efforts should focus on maximizing the prenatal detection rate during obstetrical scanning.
- © 2012 by American Heart Association, Inc.