Integrated Prenatal and Postnatal Management for Neonates with Transposition of the Great Arteries: Thirteen-Year Experience at A Single Center

Abstract Background Transposition of the great arteries (TGA) is the most common cyanotic congenital heart defect in neonates with low prenatal detection rate. This study sought to review the prenatal diagnosis, associated abnormalities, and mid-term postnatal outcomes of fetuses with TGA and investigate the integrated prenatal and postnatal management for TGA neonates. Methods Children born with prenatal diagnosis of TGA in Guangdong Provincial People’s Hospital from January 2009 to December 2022 were included in the study. The prenatal ultrasound data and neonatal records were reviewed to assess the accuracy of prenatal diagnosis. Univariate and multivariate logistic and Cox analyses were used to analyze the correlation between risk factors and prognosis of TGA patients. Results 134 fetuses with prenatal diagnosis of TGA were included in this study and assessed at a median follow-up of 1.57 years [interquartile range (IQR) 0.07–4.28]. The population originated from 40 cities in 10 provinces in China, with integrated antenatal and postnatal management rate reaching 94.0% (126/134) and a high accuracy rate (99.3%) of prenatal primary diagnosis. There were 3 (2.2%) postnatal deaths, 118 (88.1%) patients undergoing Arterial switch operation (ASO), 3 (2.2%) undergoing Restelli operations and 5 (3.7%) doing stage operations. Of 118 patients receiving ASO, the major morbidity occurred in 64 patients, with gestational ages at birth (OR = 0.953, 95% CI 0.910–0.991; P = 0.025) and cardiopulmonary bypass time (OR = 1.010, 95% CI 1.000-1.030; P = 0.038) as independent risk factors. 26.3 percent (n = 31) experienced right ventricular outflow tract obstruction (RVOTO) after surgery. Independent risk factors was aortic cross-clamping time (HR = 1.030, 95% CI 1.000-1.050; P = 0.017). Conclusion Premature infants is significantly associated with increased morbidity. Integrated prenatal and postnatal management is recommended for those with prenatal diagnosis of TGA.