Prenatal echocardiographic predictors that increase the risk of urgent Ballon Atrial Septostomy (BAS) after birth in patients with Dextro-Transposition of the Great Arteries- Retrospective Study from Tertiary Center Lodz- Poland ICZMP (2014-2024).

OBJECTIVE

Dextro-transposition of the great arteries (d-TGA) is a critical congenital heart disease (CHD) requiring prompt postnatal intervention, primarily: a line for Prostin infusion, hospitalization in an Intensive Care Unit, and in some cases, Balloon Atrial Septostomy (BAS) as a rescue procedure before planned Arterial Switch Operation (ASO). In this part, we focus on prenatal prediction of postnatal BAS.

MATERIALS AND

METHODS

This retrospective study was conducted at the Department of Prenatal Cardiology, Polish Mother's Memorial Hospital in Lodz, covering the years 2014-2024. From a total of 112 prenatally diagnosed d-TGA cases, 70 fetuses (46 with isolated d-TGA and 24 with d-TGA and VSD) met the inclusion criteria; follow-up of four pregnancies ended up in other hospitals, so the final series was 66 cases. Statistical analyses were performed using Statistica software.

RESULTS

Out of 66 analyzed cases, 32 newborns (48%) required postnatal BAS, with 87.5% of these procedures performed within the first 24-48 hours of life. Prenatal echocardiography correctly predicted the postnatal management pathway in 90.9% of cases (60/66), identifying all 26 neonates requiring urgent balloon atrial septostomy (100% positive predictive value), while 6 neonates in the planned group required unexpected postnatal septostomy. We noted that the 18% (n=6) of cases not identified prenatally occurred when the last scan was performed > 14 days before birth, suggesting that the time interval significantly impacts the reliability of late-gestation FO assessment. The study identified 10 prenatal "red flags," including FO size < 3 mm, bi-directional FO flow, and pulmonary vein velocity ≥ 45 cm/s and other features, as high-reliability indicators for urgent postnatal intervention.

CONCLUSION

Prenatal functional assessment of the foramen ovale in the late third trimester was highly effective in predicting the need for postnatal urgent BAS in d-TGA cases. The accuracy of these "red flags" was significantly higher when the last fetal echocardiogram was performed within 14 days to delivery.