J Matern Fetal Neonatal Med. 2026 Dec;39(1):2722568. doi: 10.1080/14767058.2026.2722568. Epub 2026 Sep 10.
ABSTRACT
OBJECTIVE: To evaluate prenatal and postnatal outcomes of fetuses with transposition of the great arteries (TGA) and to identify prognostic factors affecting neonatal survival.
METHODS: This retrospective study included fetuses prenatally diagnosed with TGA between January 2015 and December 2024 at a tertiary referral center. Diagnosis was based on fetal echocardiography demonstrating normal atrioventricular connections with ventriculo-arterial discordance and a parallel course of the great arteries. Perinatal management included planned delivery at a tertiary center, prostaglandin E1 infusion, and arterial switch operation (ASO). Postnatal data included balloon atrial septostomy (BAS), coronary artery anomalies, extracorporeal membrane oxygenation (ECMO), and survival.
RESULTS: A total of 116 neonates with postnatally confirmed d-TGA were analyzed. Of these, 63 (54.3%) were male and 53 (45.7%) female. BAS was performed in 23/116 (19.8%), not performed in 66/116 (56.9%), and data were not available in 27/116 (23.3%) cases. BAS was required in neonates with restrictive interatrial communication, indicating inadequate intercirculatory mixing. Coronary artery anomalies were identified in 8/116 (6.9%) cases and were significantly more frequent among non-survivors (30.8% vs 4.9%; OR 11.0, 95% CI 2.35-51.56; p = 0.005). Postnatal mortality occurred in 13/116 (11.2%), mainly related to coronary anomalies and severe hemodynamic instability. The overall postnatal survival rate was 88.8% (103/116).
CONCLUSION: Prenatal diagnosis of d-TGA enables delivery in tertiary centers with immediate prostaglandin support and timely intervention. Early outcome is primarily determined by effective intercirculatory mixing and coronary artery anatomy.
PMID:42721384 | DOI:10.1080/14767058.2026.2722568