Complex Fetal Care Cases: Delivery Planning and Emergent Neonatal Intervention in Transposition of the Great Arteries

* Abbreviations: CICU: : cardiac intensive care unit d-TGA: : dextro-transposition of the great arteries FIO2: : fraction of inspired oxygen A 20-year-old gravida 2, para 1 pregnant woman was referred to our fetal care center because of a diagnosis of structural heart disease in the fetus. The woman’s medical history included asthma, seasonal allergies, and depression, with no surgical history. She had 1 prior term vaginal delivery. This pregnancy had been complicated by late presentation to prenatal care at 20 weeks’ gestation. Her medications included asthma maintenance medications and prenatal vitamins. Pertinent family history included her partner who had a ventricular septal defect and a paternal male first cousin with transposition of the great arteries. Prenatal laboratory test results were unremarkable and genetic screening was declined. Imaging at the referring obstetrician’s office was significant for transposition of the great arteries with an intact ventricular septum and normal fetal biometry. She was referred to our center at 21 1/7 weeks’ gestation, with imaging and consultation with fetal cardiology at 21 6/7 weeks’ gestation. The following tests were performed: Figure 1. Four-chamber view of the heart at 21 weeks’ gestation, swept to the outflow tracts showing parallel arrangement of the great arteries with the pulmonary artery (PA) located posteriorly and arising from the left ventricle (LV) and the aorta (Ao) arising from the right ventricle (RV). Fetal position: right (R), left (L), anterior (A), posterior (P). At …