Prenatal features of ductus arteriosus constriction and restrictive foremen ovale in d-transposition of the great arteries

Background-Although most neonates with d-transposition of the great arterie s (TGA) have an uncomplicated preoperative course, some with a restrictive foramen ovale (FO), ductus arteriosus (DA) constriction, or pulmonary hyper tension may be severely hypoxemic and even die shortly after birth. Our goa l was to determine whether prenatal echocardiography can identify these hig h-risk fetuses with TCA. Methods and Results-We reviewed the prenatal and postnatal echocardiograms and outcomes of 16 fetuses with TGA/intact ventricular septum or small vent ricular septal defect. Of the 16 fetuses, 6 prenatally had an abnormal FO ( fixed position, flat, and/or redundant septum primum). Five of the 6 had re strictive FO at birth. Five fetuses had DA narrowing at the pulmonary arter y end in utero, and 6 had a small DA (diameter z score of <-2.0). Of 4 fetu ses with the most diminutive DA, 2 also had an abnormal appearance of the F O, and both died immediately after birth. One other fetus had persistent pu lmonary hypertension. Eight fetuses had abnormal Doppler flow pattern in th e DA (continuous high-velocity flow, n=1; retrograde diastolic flow, n=7), Conclusions-Abnormal features of the FO, DA, or both are present in fetuses with TGA at high risk for postnatal hypoxemia. These features may result f rom the abnormal intrauterine hemodynamics in TGA. A combination of restric tive FO and DA constriction in TGA may be associated with early neonatal de ath.