Abstract 20794: Prenatal Predictors of Urgent Postnatal Balloon Atrial Septostomy in Transposition of Great Arteries
Nita Ray Chaudhuri, MD1, Prasad Ravi, MD2, Lisa K Hornberger, MD3, Shanthi Sivanandam, MD4
Background: Prenatal risk factors for poor outcomes in neonates with transposition of the great arteries are restrictive fossa ovalis (FO) and thickened atrial septum. There is limited data to assess size of fossa ovalis which makes it restrictive prenatally.
Aim: To determine urgent postnatal balloon atrial septostomy (BAS) based on effective orifice of fossa ovalis prenatally.
Materials and Methods: Prenatal echocardiograms of 50 fetuses with transposition of great arteries were reviewed retrospectively from University of Alberta (n=39) and University of Minnesota (n=11) from 2003 to 2016.
Results: Mean GA at diagnosis 33 weeks. 13 of 50 (26%) required urgent BAS within 2 hours after birth, in addition 18 of 50 (36%) required BAS > 2 hours after birth. In total, 31 (62%) required BAS within first day of life. 19 of 50 (38%) did not require BAS. 13 that required urgent BAS had restrictive fossa ovalis measuring <= 6mm. 18 that required BAS > 2 hours after birth and had fossa ovalis measuring 6-7 mm. 19 that did not require BAS had nonrestrictive fossa ovalis measuring >7 mm. A restrictive fossa ovalis of <=6 mm predicted urgent need for BAS within 2 hours after birth (sensitivity 0.60, specificity 0.84, positive predictive value 0.86). Ratio of fossa ovalis size to interatrial septum of <=0.3 predicted urgent need for BAS within 2 hours after birth (sensitivity 0.47, specificity 0.95, positive predictive value 0.93). 22 of 31 (71%) that required BAS had thick atrial septum. 19 (100%) that did not require BAS had thin atrial septum.
Conclusion: Effective orifice of fossa ovalis and ratio of fossa ovalis to interatrial septum are predictors for the need for urgent BAS postnatally. Increased thickness of atrial septum causes restriction of effective orifice of the fossa ovalis necessitating urgent BAS postnatally. Diagram: Fossa Ovalis (FO) Sagittal view. LA; left atrium, RA; right atrium
- Cardiac imaging
- Noninvasive cardiac imaging
- Congenital heart disease
- Pediatric cardiology
Author Disclosures: N. Ray Chaudhuri: None. P. Ravi: None. L.K. Hornberger: None. S. Sivanandam: None.
- © 2016 by American Heart Association, Inc.