To improve the understanding of the pathophysiology of transposition of the great arteries with intact ventricular septum (TGA/IVS) and the cardiac remodeling occurring from fetal to neonatal life, we performed a morphometric and functional echocardiographic assessment in fetuses and newborns. This was a prospective case–control study performed in a tertiary referral center, which included fetuses and newborns with a diagnosis of TGA/IVS between 2011 and 2018. Morphometry and systolic and diastolic function parameters were compared with age and body surface-matched healthy controls. Twenty-one TGA/IVS patients were included during the study period and morphometric and functional echocardiographic data were recorded. TGA/IVS patients showed morphometric and functional changes of increased overall volume and output, predominantly in the aortic component from fetus to newborn, probably due to compensatory mechanisms secondary to brain hypoxia.
This is a preview of subscription content, log in to check access.
Buy single article
Instant unlimited access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
Patra S, Rama Sastry UM, Mahimaiha J, Subramanian AP, Shankarappa RK, Nanjappa MC (2015) Spectrum of cyanotic congenital heart disease diagnosed by echocardiographic evaluation in patients attending paediatric cardiology clinic of a tertiary cardiac care centre. Cardiol Young 25(5):861–867
Paladini D, Volpe P, Sglavo G, Vassallo M, De Robertis V, Marasini M, Russo MG (2008) Transposition of the great arteries in the fetus: assessment of the spatial relationships of the arterial trunks by four-dimensional echocardiography. Ultrasound Obstet Gynecol 31(3):271–276
Tuo G, Paladini D, Montobbio G, Volpe P, Cheli M, Calevo MG, Marasini M (2017) Prenatal echocardiographic assessment of foramen ovale appearance in fetuses with D-transposition of the great arteries and impact on neonatal outcome. Fetal Diagn Ther 42(1):48–56
Öner T, Özdemir R, Güven B, Yılmazer MM, Doksöz Ö, Meşe T, Tavlı V (2016) Evaluation of myocardial function in pediatric patients with transposition of great arteries after arterial switch operation. Anatol J Cardiol 16(1):55–61
Li YF, Zhou KY, Fang J, Wang C, Hua YM, Mu DZ (2016) Efficacy of prenatal diagnosis of major congenital heart disease on perinatal management and perioperative mortality: a meta-analysis. World J Pediatr 12(3):298–307
Hoffman JI, Kaplan S The incidence of congenital heart disease. J Am Coll Cardiol 39(12):1890–1900
Teitel D (2016) Recognition of undiagnosed neonatal heart disease. Clin Perinatol 43(1):81–98
Masutani S, Seki M, Taketazu M, Senzaki H (2009) Successful management of the persistent pulmonary hypertension of the newborn with transposition of the great arteries by restricted patency of the ductus arteriosus: a simple and rational novel strategy. Pediatr Cardiol 30(7):1003–1005
Hung JH, Huang PT, Weng ZC, Chen CY, Chao KC, Yang MJ, Hung J (2008) Prenatal diagnosis of dextrotransposition of the great arteries. J Chin Med Assoc 71(10):541–545
Escobar-Diaz MC, Freud LR, Bueno A, Brown DW, Friedman KG, Schidlow D, Emani S, Del Nido PJ, Tworetzky W (2015) Prenatal diagnosis of transposition of the great arteries over a 20-year period: improved but imperfect. Ultrasound Obstet Gynecol 45(6):678–682
Bonnet D, Coltri A, Butera G, Fermont L, Le Bidois J, Aggoun Y, Acar P, Villain E, Kachaner J, Sidi D (1999) Prenatal diagnosis of transposition of great vessels reduces neonatal morbidity and mortality. Arch Mal Coeur Vaiss 92(5):637–640
Martins P, Castela E (2008) Transposition of the great arteries. Orphanet J Rare Dis. 3:27
Blanc J, Fouron JC, Sonesson SE, Raboisson MJ, Huggon I, Gendron R, Berger A, Brisebois S (2016) Ventricular outputs, central blood flow distribution and flow pattern through the aortic isthmus of fetuses with simple transposition of the great arteries. Acta Obstet Gynecol Scand 95(6):629–634
Mukherjee D, Lindsay M, Zhang Y, Lardaro T, Osen H, Chang DC, Brenner JI, Abdullah F (2010) Analysis of 8681 neonates with transposition of the great arteries: outcomes with and without Rashkind balloon atrial septostomy. Cardiol Young 20(4):373–380
Gu X, Zhang Y, Han J, Liu X, Ge S, He Y (2018) Isolated premature restriction or closure of foramen ovale in fetuses: echocardiographic characteristics and outcome. Echocardiography. 35:1189–1195
McQuillen PS, Hamrick SE, Perez MJ, Barkovich AJ, Glidden DV, Karl TR, Teitel D, Miller SP (2006) Balloon atrial septostomy is associated with preoperative stroke in neonates with transposition of the great arteries. Circulation 113(2):280–285
Skinner J, Hornung T, Rumball E (2008) Transposition of the great arteries: from fetus to adult. Heart 94(9):1227–1235
Freed DH, Robertson CM, Sauve RS, Joffe AR, Rebeyka IM, Ross DB, Dyck JD (2006) Western Canadian Complex Pediatric Therapies Project Follow-up Group: Intermediate-term outcomes of the arterial switch operation for transposition of great arteries in neonates: alive but well? J Thorac Cardiovasc Surg 132(4):845–852
Oxenius A, Hug MI, Dodge-Khatami A, Cavigelli-Brunner A, Bauersfeld U, Balmer C (2010) Do predictors exist for a successful withdrawal of preoperative prostaglandin E(1) from neonates with d-transposition of the great arteries and intact ventricular septum? Pediatr Cardiol 31(8):1198–1202
Beattie LM, McLeod KA (2009) Prostaglandin E2 after septostomy for simple transposition (2009). Pediatr Cardiol. 30(4):447–451
Rodriguez-Guerineau L, Perez-Cruz M, Gomez Roig MD, Cambra FJ, Carretero J, Prada F, Gómez O, Crispi F, Bartrons J (2018) Cardiovascular adaptation to extrauterine life after intrauterine growth restriction. Cardiol Young 28(2):284–291
Guirado L, Crispi F, Masoller N, Bennasar M, Marimon E, Carretero J, Gratacós E, Martínez JM, Friedberg MK, Gómez O (2018) Biventricular impact of mild to moderate fetal pulmonary valve stenosis. Ultrasound Obstet Gynecol 51(3):349–356
Godfrey ME, Friedman KG, Drogosz M, Rudolph AM, Tworetzky W (2017) Cardiac output and blood flow redistribution in fetuses with D-loop transposition of the great arteries and intact ventricular septum: insights into pathophysiology. Ultrasound Obstet Gynecol 50(5):612–617
Porayette P, van Amerom JF, Yoo SJ, Jaeggi E, Macgowan CK, Seed M (2015) MRI shows limited mixing between systemic and pulmonary circulations in foetal transposition of the great arteries: a potential cause of in utero pulmonary vascular disease. Cardiol Young 25(4):737–744
Vaujois L, Boucoiran I, Preuss C, Brassard M, Houde C, Fouron JC, Raboisson MJ (2017) Relationship between interatrial communication, ductus arteriosus, and pulmonary flow patterns in fetuses with transposition of the great arteries: prediction of neonatal desaturation. Cardiol Young 27(7):1280–1288
Punn R, Silverman NH (2011) Fetal predictors of urgent balloon atrial septostomy in neonates with complete transposition. J Am Soc Echocardiogr 24(4):425–430
Ishii Y, Inamura N, Kawazu Y, Kayatani F, Arakawa H (2013) 'I-shaped' sign in the upper mediastinum: a novel potential marker for antenatal diagnosis of D-transposition of the great arteries. Ultrasound Obstet Gynecol 41(6):667–671
Vigneswaran TV, Zidere V, Miller OI, Simpson JM, Sharland GK (2017) Usefulness of the prenatal echocardiogram in fetuses with isolated transposition of the great arteries to predict the need for balloon atrial septostomy. Am J Cardiol 119(9):1463–1467. https://doi.org/10.1016/j.amjcard.2017.01.017
Sallaam S, Natarajan G, Aggarwal S (2016) Persistent pulmonary hypertension of the newborn with D-transposition of the great arteries: management and prognosis. Congenit Heart Dis 11(3):239–244
Conflict of interest
All authors declare that they have non-financial interests.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Walter, C., Soveral, I., Bartrons, J. et al. Comprehensive Functional Echocardiographic Assessment of Transposition of the Great Arteries: From Fetus to Newborn. Pediatr Cardiol (2020). https://doi.org/10.1007/s00246-019-02279-w
- Transposition of great arteries
- Congenital heart disease
- Pulmonary hypertension