Resumen

PINHEIRO, Adriana et al. The benefit of prenatal diagnosis in transposition of great arteries . Nascer e Crescer [online]. 2011, vol.20, n.2, pp.87-91. ISSN 0872-0754.

Objective:To study the impact of prenatal diagnosis (PND) of transposition of the great arteries (TGA) on perioperative morbidity and mortality in a pediatric cardiology center. Methods: Retrospective study of newborns (NB) with sim­ple TGA, with and without PND, who underwent corrective sur­gery, between January 2007 and July 2010. The following vari­ables were analysed: clinical characteristics of the patients, age at surgery, duration of circulatory arrest, and outcome. Statistical analysis included the Student t and the X² tests. Statistical signifi­cance was assessed by use of a cutoff value of P =0,05. Results: Among a total of 31 NB with TGA we isolated 17 cases of simple TGA, six with PND (Group 1) and 11 with neo­natal diagnosis (Group 2). Deliveries of group 1 were all in terti­ary hospital by caesarean section. The NB of Group 2 started prostaglandins at a mean time of 26,7 hours (h). The Rashkind procedure was carried out at a mean time of 27,2h vs 55,1h. In the second group the intensive care unit (ICU) admission occurred at 20,4h. The minimum oxygen saturation in preoperative varied between 82-95% vs 30-80%. In the first group 16,7% of the NB had preoperative metabolic acidosis vs 54,5% and maximum creatinine value varied between 0,5-0,8 mg/dl vs 0,6-1,1. The surgeries of the 1^st group occurred on average at 9,0 days (d) of life vs 11,5d. Extra-corporal circulation and ventilation sup­port durations were similar in both groups. The mean ICU stay was 4,7d vs 7,4d and the mean total hospital stay was 12,0d vs 29,9d. Complications in postoperative period: group 1 - cardiac tamponade (1), necrotizing enterocolitis (1); group 2: ventricular fibrillation (1), compressive hemothorax (1), transitory complete atrioventricular block (1), sepsis (1), diaphragm paresis (1), peri­cardial effusion (1) and death (1). Conclusion: The PND of TGA allowed us to schedule delivery in optimal conditions and provide adequate management, avoiding complications such as prolonged hypoxemia and metabolic acidosis.

Palabras clave : Transposition of great arteries; prenatal diagnosis; perioperative morbidity.

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