Fetal dextro-transposition of the great arteries: a narrative review of management and neurodevelopmental outcomes

Fetal dextro-transposition of the great arteries (d-TGA) represents a severe cyanotic congenital heart defect. Without effective intracardiac communication, affected neonates face life-threatening hypoxemia and acidosis shortly after birth. Recent investigations have unveiled an additional dimension: d-TGA patients experience compromised cerebral development and inadequate oxygen delivery beginning in utero , subsequently manifesting as executive dysfunction and other neurodevelopmental challenges throughout childhood and adolescence—obstacles that now constitute the primary barriers to favorable long-term outcomes. Advances in prenatal ultrasonographic diagnosis, artificial intelligence-assisted technologies, and integrated multidisciplinary perinatal management have substantially elevated survival rates in recent years. Nevertheless, persistent clinical challenges remain: suboptimal prenatal detection rates, incomplete genetic counseling frameworks, insufficiently delineated perinatal treatment pathways, and delayed interventions for neurodevelopmental impairments. This narrative review integrates current knowledge regarding fetal d-TGA, endeavoring to provide actionable insights for clinical diagnosis, therapeutic strategies, and comprehensive management.