Key result
Complex forms of transposition of the great arteries were associated with a significantly higher short-term mortality rate compared to simple forms (12.8% vs. 1.9%, p=0.038).
Why the study?
How accurate is fetal echocardiography in diagnosing TGA types, and what are the short-term outcomes for these fetuses?
Cohort (n=94)
No
How accurate is fetal echocardiography in diagnosing TGA types, and what are the short-term outcomes for these fetuses?
Absolute Event Rate: 12.8% vs 1.9%
p-value: p=0.038
Fetal echocardiography is highly accurate (93.3%) for diagnosing TGA types, and fetuses with simple TGA have significantly better short-term survival than those with complex forms.
Supports differential fetal counseling by TGA complexity; leaves open confirmation in larger prospective cohorts.
OBJECTIVE: To review our series of prenatally diagnosed transposition of the great arteries (TGA) to analyze the accuracy of fetal echocardiography for achieving a precise diagnosis of the TGA type (simple vs. complex) and to examine the short-term outcome. METHODS: A total of 94 cases of simple and complex TGA types (ventriculoarterial discordance with atrioventricular concordance) prenatally evaluated in our referral center between 1998 and 2014 were included. Fetuses with additional congenital anomalies and those with incomplete follow-up were excluded. Prenatal diagnostic accuracy and short-term survival were analyzed for the different types of TGA. RESULTS: The TGA type was correctly ascertained prenatally in 93.3%. Most fetuses were diagnosed with simple TGA (62.7%). There were 6 discrepancies: 5 fetuses with simple TGA had postnatally TGA + ventricular septal defect (VSD; n = 3) or TGA + VSD + coarctation of the aorta (n = 2), and 1 fetus with TGA + VSD postnatally showed severe left ventricular outflow tract obstruction. The mortality rate was 6.6%; it was higher in complex versus simple forms (12.8 vs. 1.9%, p = 0.038), and in cases with intramural coronary artery versus those without (60 vs. 3.5%, p < 0.001). We found no relationship between the arrangement of the great arteries and coronary arterial abnormalities. CONCLUSIONS: Simple TGA has a better outcome than the complex forms. A discrepancy rate of 7% with potential influence on the prognosis of survival between the prenatal diagnosis of the TGA type and the definitive diagnosis was found.
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Domínguez-Manzano et al. (2016) conducted a cohort in Transposition of the great arteries (TGA) (n=94). Complex TGA vs. Simple TGA was evaluated on Short-term mortality rate (p=0.038). Complex forms of transposition of the great arteries were associated with a significantly higher short-term mortality rate compared to simple forms (12.8% vs. 1.9%, p=0.038).
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