Premium
Transposition of the great arteries: Fetal pulmonary valve growth and postoperative neo‐aortic root dilatation
Author(s) -
Palen Roel L.F.,
Zee Carlijn,
Vink Arja S.,
Knobbe Ingmar,
Jurgens Sean J.,
Leeuwen Elizabeth,
Bax Caroline J.,
Marchie Sarvaas Gideon J.,
Blom Nico A.,
Haak Monique C.,
Bilardo Caterina M.,
Clur SallyAnn B.
Publication year - 2019
Publication title -
prenatal diagnosis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.956
H-Index - 97
eISSN - 1097-0223
pISSN - 0197-3851
DOI - 10.1002/pd.5539
Subject(s) - great arteries , fetus , medicine , pulmonary valve , cardiac skeleton , cardiology , aortic valve , transposition of the great vessels , transposition (logic) , fetal echocardiography , aortic root , prenatal diagnosis , aorta , pregnancy , heart disease , biology , linguistics , philosophy , genetics
Objectives Documentation of semilunar valve growth in fetal transposition of the great arteries (TGA) and the relationship between neo‐aortic root (NAoR) dilatation, a cause for postoperative reinterventions after the arterial switch operation (ASO), and pulmonary valve (PV) annulus dimensions prenatally. Methods This retrospective multicenter observational study included TGA fetuses suitable for ASO. Semilunar valve annuli pre‐ASO and NAoR diameters (post‐ASO) were measured. Trends in annulus diameters were analyzed using a linear mixed‐effects model and compared with normal values. Prenatal semilunar valve Z ‐scores were correlated with NAoR diameters post‐ASO. Results We included 137 TGA fetuses (35.8% with significant ventricular septal defects [VSDs]). One hundred twenty‐one underwent ASO. Fetal TGA‐PV diameters were significantly larger than control aortic valve (AoV) and PV annuli from 23 and 27 weeks, respectively, especially when a VSD was present. Fetal TGA‐AoV annuli were significantly larger than control AoV and PV annuli from 26 and 30 weeks, respectively. Z ‐scores of fetal TGA‐PV and NAoR diameter at last follow‐up correlated significantly ( P < .001 at 26‐30 wk). Conclusion Fetal TGA semilunar valve annuli are larger than control annuli, especially when there is a significant VSD. Factors besides postoperative hemodynamics, including fetal anatomy, PV Z ‐score, prenatal flow, connective tissue properties, and genetics, may influence the risk for late reintervention in these fetuses.