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Relationship between interatrial communication, ductus arteriosus, and pulmonary flow patterns in fetuses with transposition of the great arteries: prediction of neonatal desaturation

Published online by Cambridge University Press:  05 April 2017

Laurence Vaujois ,
Isabelle Boucoiran ,
Christophe Preuss ,
Myriam Brassard ,
Christine Houde ,
Jean C. Fouron  and
Marie-Josée Raboisson
Laurence Vaujois
Affiliation:
Department of Paediatrics, Division of Paediatric Cardiology, Sainte-Justine University Hospital Center, Montréal, Québec, Canada Department of Paediatrics, Division of Paediatric Cardiology, Laval University, Québec City, Canada
Isabelle Boucoiran
Affiliation:
Division of Obstetrics and Gynecology, Sainte-Justine University Hospital Center, Montréal, Québec, Canada
Christophe Preuss
Affiliation:
Research Center, Sainte-Justine University Hospital Center, Montréal, Québec, Canada
Myriam Brassard
Affiliation:
Department of Paediatrics, Division of Paediatric Cardiology, Sainte-Justine University Hospital Center, Montréal, Québec, Canada
Christine Houde
Affiliation:
Department of Paediatrics, Division of Paediatric Cardiology, Laval University, Québec City, Canada
Jean C. Fouron
Affiliation:
Department of Paediatrics, Division of Paediatric Cardiology, Sainte-Justine University Hospital Center, Montréal, Québec, Canada
Marie-Josée Raboisson*
Affiliation:
Department of Paediatrics, Division of Paediatric Cardiology, Sainte-Justine University Hospital Center, Montréal, Québec, Canada
*
Correspondence to: M.-J. Raboisson, MD, Division of Cardiology, CHU Sainte-Justine, 3175 Chemin de la Côte Sainte Catherine, Montréal, QC, Canada H3T 1C5. Tel: +001 514 345 4931, ext 5410; Fax: +001 514 345 4896; E-mail: [email protected]
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Abstract

Background

The relationship between interatrial communication, ductus arteriosus, and pulmonary flow in transposition of the great arteries and intact ventricular septum may help predict postnatal desaturation.

Methods

Echocardiographic data of 45 fetuses with transposition of the great arteries and intact ventricular septum and 50 age-matched controls were retrospectively reviewed. Interatrial communication, left and right ventricular output, flow in the ductus arteriosus, as well as effective pulmonary flow were measured. Patients were divided into two groups on the basis of postnatal saturations: group 1 had saturations ⩽50% and group 2 >50%.

Results

Of 45 fetuses, 13 (26.7%) were classified into group 1. Compared with fetuses in group 2, they had a smaller interatrial communication (2.9 versus 4.0 mm, p=0.004) and more retrograde diastolic flow in the ductus arteriosus (92 versus 23%, p=0.002). Both groups showed a significant decrease in ductal flow compared with controls. Patients in group 2 had a higher effective pulmonary flow compared with controls. There was a mild correlation between left ventricular output and size of the interatrial communication (Spearman’s rank correlation 0.44).

Conclusion

A retrograde diastolic flow is present in most of the fetuses with postnatal desaturation. Fetuses with transposition of the great arteries have a lower flow through the ductus arteriosus compared with controls. Fetuses without restrictive foramen ovale have higher effective pulmonary flow. Peripheral pulmonary vasodilatation due to higher oxygen saturation in pulmonary arteries in the case of transposition of the great arteries could be one possible cause.

Keywords

Transposition of the great arteriesneonatal hypoxiarestrictive foramen ovalefetal circulationprenatal ductal flow
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Issue 7 , September 2017 , pp. 1280 - 1288
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Copyright
© Cambridge University Press 2017 

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