Transposition of the great arteries: Fetal pulmonary valve growth and postoperative neo-aortic root dilatation.


van der Palen RLF, van der Zee C, Vink AS, Knobbe I, Jurgens SJ, van Leeuwen E, Bax CJ, du Marchie Sarvaas GJ, Blom NA, Haak MC, Bilardo CM, Clur SB.

Prenat Diagn. 2019 Jul 27. doi: 10.1002/pd.5539. [Epub ahead of print]


Take Home Points:

  • Neoaortic root dilation is common and occasionally needs intervention in patients born with transposition of great arteries (TGA) who underwent an arterial switch operation.
  • In this longitudinal study of semilunar valve size in fetal TGA subjects, semilunar valve diameters are larger than in the normal fetus, especially in those with TGA and VSD.
  • Prenatal pulmonary valve size at 26 to 30 weeks determines neoaortic root size after arterial switch procedure in patients with TGA.

Commentary from Dr. Shaji Menon (Salt Lake City), section editor of Pediatric Cardiology Journal Watch: This is a retrospective multicenter observational study of 137 fetuses with TGA; 36% with ventricular septal defects.  Arterial switch operation was performed in 121 subjects.  Fetal semilunar valve diameters were significantly larger than control aortic valve diameters, especially in patients with VSD.  There was positive correlation between Z‐scores of fetal TGA pulmonary valve at 26 to 30 weeks and neoaortic valve diameter at last follow‐up (P < .001).