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Obstetrical & Gynecological Survey
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by: Guest
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In transposition of the great arteries (TGA)-a relatively common congenital cardiac anomaly-the aorta and pulmonary artery are connected, respectively, to the right and left ventricular outflow tracts. TGA may be detected by antenatal ultrasound scanning provided that the cardiac views include the outflow tracts. This retrospective review was intended to determine how sensitively scanning for fetal anomalies detects TGA, and whether prenatal detection improves survival. A population-based study in the Wessex region of the United Kingdom, conducted over the years 1994 to 2006, yielded 72 infants who had TGA as the only cardiac abnormality and who had an intact ventricular septum. The population prevalence of all cases of TGA was 33.6 per 100,000 live births, and the prevalence of isolated TGA was 20.6 per 100,000.
TGA, which occurred more often in boys than in girls, was detected antenatally in only 6.9% of cases during the period under review. The rate improved to 25% in the last 4 years of the study. TGA was detected 40% of the time when associated with a ventricular septal defect. All 5 infants who were diagnosed antenatally underwent surgery and survived. Of the 67 infants in whom TGA was not diagnosed antenatally, 2 were stillborn and 5 died before a diagnosis could be made. All of the remaining 60 underwent surgery, and 4 died in the postoperative period (3 of surgical complication, 1 of prematurity). The difference in survival between those who were, and those who were not diagnosed antenatally was not statistically significant. Nevertheless, antenatal screening could have averted some of these deaths.
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