{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T00:49:20Z","timestamp":1792111760535,"version":"4.4.0"},"reference-count":63,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2021,5,3]],"date-time":"2021-05-03T00:00:00Z","timestamp":1620000000000},"content-version":"vor","delay-in-days":2,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp; Gyne"],"published-print":{"date-parts":[[2021,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To investigate the impact of abnormal perinatal loading conditions on cardiac geometry and function in term fetuses and neonates with transposition of the great arteries with intact interventricular septum (simple TGA), and to explore the predictive value of fetal cardiac parameters for an urgent balloon atrial septostomy (BAS) after birth.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a prospective longitudinal follow\u2010up study of women delivering at term, including both uncomplicated pregnancies with normal outcome and pregnancies affected by fetal simple TGA. Conventional, spectral\u2010tissue Doppler and speckle\u2010tracking echocardiographic parameters were obtained within 1\u2009week before delivery and within the first few hours after delivery. Neonates with simple TGA that required urgent BAS were assessed after the procedure and before corrective arterial switch surgery. Cardiac parameters were normalized by cardiac cycle length, ventricular end\u2010diastolic length or end\u2010diastolic dimension, as appropriate. Fetal and neonatal cardiac parameters were compared between simple\u2010TGA cases and controls, and perinatal changes in the simple\u2010TGA group were assessed. Receiver\u2010operating\u2010characteristics (ROC)\u2010curve analysis was used to assess the predictive value of fetal cardiac parameters for urgent BAS after birth in the simple\u2010TGA group.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 67 pregnant women delivering at term were included in the study (54 normal pregnancies and 13 with a diagnosis of fetal simple TGA). Compared with normal term fetuses, term fetuses with simple TGA exhibited more globular hypertrophied ventricles, increased biventricular systolic function and diastolic dysfunction (right ventricular (RV) sphericity index (SI), 0.58 <jats:italic>vs<\/jats:italic> 0.54; left ventricular (LV)\u2010SI, 0.55 <jats:italic>vs<\/jats:italic> 0.49; combined cardiac output (CCO), 483 <jats:italic>vs<\/jats:italic> 406\u2009mL\/min\/kg; LV torsion, 4.3 <jats:italic>vs<\/jats:italic> 3.0\u2009deg\/cm; RV isovolumetric relaxation time (IVRT\u2032), 127 <jats:italic>vs<\/jats:italic> 102\u2009ms; <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.01 for all). Compared with normal neonates, neonates with simple TGA demonstrated biventricular hypertrophy, a more spherical right ventricle and altered systolic and diastolic functional parameters (RV\u2010SI, 0.61 <jats:italic>vs<\/jats:italic> 0.43; RV myocardial performance index, 0.47 <jats:italic>vs<\/jats:italic> 0.34; CCO, 697 <jats:italic>vs<\/jats:italic> 486\u2009mL\/min\/kg; LV\u2010IVRT\u2032, 100 <jats:italic>vs<\/jats:italic> 79\u2009ms; RV\u2010IVRT\u2032, 106 <jats:italic>vs<\/jats:italic> 71\u2009ms; <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001 for all). Paired comparison of neonatal and fetal cardiac indices in the simple\u2010TGA group showed persistence of the fetal phenotype, increased biventricular systolic myocardial contractility and CCO, and diastolic dysfunction (RV systolic myocardial velocity (S\u2032), 0.31 <jats:italic>vs<\/jats:italic> 0.24\u2009cm\/s; LV\u2010S\u2032, 0.23 <jats:italic>vs<\/jats:italic> 0.18\u2009cm\/s; CCO, 697 <jats:italic>vs<\/jats:italic> 483\u2009mL\/min\/kg; LV torsion, 1.1 <jats:italic>vs<\/jats:italic> 4.3\u2009deg\/cm; <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001 for all). Several fetal cardiac parameters in term fetuses with simple TGA demonstrated high predictive value for an urgent BAS procedure after birth. Our proposed novel fetal cardiac index, LV rotation\u2010to\u2010shortening ratio, as a potential marker of subendocardial dysfunction, for a cut\u2010off value of \u2265\u20090.23, had an area under the ROC curve (AUC) of 0.94, sensitivity of 100% and specificity of 83%. For RV\/LV end\u2010diastolic area ratio \u2265\u20091.33, pulmonary\u2010valve\u2010to\u2010aortic\u2010valve\u2010dimension ratio \u2264\u20090.89, RV\/LV cardiac output ratio \u2265\u20091.38 and foramen\u2010ovale\u2010dimension\u2010to\u2010total\u2010interatrial\u2010septal\u2010length ratio \u2264\u20090.27, AUC was 0.93\u20130.98, sensitivity was 86% and specificity was 83\u2013100% for all.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Simple\u2010TGA fetuses exhibited cardiac remodeling at term with more profound alterations in these cardiac parameters after birth, suggestive of adaptation to abnormal loading conditions and possible adaptive responses to hypoxemia. Perinatal adaptation in simple TGA might reflect persistence of the abnormal parallel arrangement of cardiovascular circulation and the presence of widely patent fetal shunts imposing volume load on the neonatal heart. The fetal cardiac parameters that showed high predictive value for urgent BAS after birth might reflect the impact of late\u2010gestation pathophysiology and progressive hypoxemia on fetal cardiac geometry and function in simple TGA. If these findings are validated in larger prospective studies, detailed cardiac assessment of fetuses with simple TGA near term could facilitate improvements in perinatal management and refinement of the timing of postnatal intervention strategies to prevent adverse pregnancy outcomes. \u00a9 2020 International Society of Ultrasound in Obstetrics and Gynecology<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.22164","type":"journal-article","created":{"date-parts":[[2020,7,31]],"date-time":"2020-07-31T04:01:39Z","timestamp":1596168099000},"page":"756-768","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Urgent neonatal balloon atrial septostomy in simple transposition of the great arteries: predictive value of fetal cardiac parameters"],"prefix":"10.1002","volume":"57","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8008-5144","authenticated-orcid":false,"given":"O.","family":"Patey","sequence":"first","affiliation":[{"name":"Molecular &amp; Clinical Sciences Research Institute, St George's University of London  London UK"},{"name":"Fetal Medicine Unit St George's University Hospitals NHS Foundation Trust  London UK"},{"name":"Brompton Centre for Fetal Cardiology Royal Brompton and Harefield Hospitals NHS Foundation Trust  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. S.","family":"Carvalho","sequence":"additional","affiliation":[{"name":"Molecular &amp; Clinical Sciences Research Institute, St George's University of London  London UK"},{"name":"Fetal Medicine Unit St George's University Hospitals NHS Foundation Trust  London UK"},{"name":"Brompton Centre for Fetal Cardiology Royal Brompton and Harefield Hospitals NHS Foundation Trust  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5531-4301","authenticated-orcid":false,"given":"B.","family":"Thilaganathan","sequence":"additional","affiliation":[{"name":"Molecular &amp; Clinical Sciences Research Institute, St George's University of London  London UK"},{"name":"Fetal Medicine Unit St George's University Hospitals NHS Foundation Trust  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,5,3]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1017\/S1047951100009082"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2014.06.1150"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1186\/1750-1172-3-27"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.99.9.1209"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000144141.18560.CF"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2010.12.020"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1017\/S1047951114000870"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2017.01.017"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.17469"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1080\/14767058.2020.1725883"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1017\/S1047951117000087"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1159\/000448995"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.12892"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.17370"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.21920"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00246-019-02279-w"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.99.7.916"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1203\/pdr.0b013e318030d5b9"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2015.07.005"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCIMAGING.113.001490"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.14841"},{"key":"e_1_2_7_23_1","first-page":"224","article-title":"Echocardiographic evaluation of systolic and diastolic left ventricular function following arterial switch operation in the neonatal period for transposition of the great arteries","volume":"27","author":"Crepaz R","year":"1997","journal-title":"Midterm results. G Ital Cardiol"},{"key":"e_1_2_7_24_1","first-page":"137","article-title":"Impact of left ventricular function on early outcomes after arterial switch for D\u2010transposition of great arteries with intact ventricular septum","volume":"59","author":"Adhyapak SM","year":"2007","journal-title":"Indian Heart J"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2013.07.194"},{"key":"e_1_2_7_26_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.68.4.733"},{"key":"e_1_2_7_27_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.17365"},{"key":"e_1_2_7_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0894-7317(14)80366-0"},{"key":"e_1_2_7_29_1","doi-asserted-by":"publisher","DOI":"10.1111\/echo.12051"},{"key":"e_1_2_7_30_1","doi-asserted-by":"publisher","DOI":"10.1002\/mrm.10679"},{"key":"e_1_2_7_31_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.20261"},{"key":"e_1_2_7_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2017.01.011"},{"key":"e_1_2_7_33_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.19193"},{"key":"e_1_2_7_34_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.20187"},{"key":"e_1_2_7_35_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.17521"},{"key":"e_1_2_7_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2019.05.023"},{"key":"e_1_2_7_37_1","doi-asserted-by":"publisher","DOI":"10.1136\/adc.2007.128777"},{"key":"e_1_2_7_38_1","doi-asserted-by":"publisher","DOI":"10.1203\/00006450-199305000-00022"},{"key":"e_1_2_7_39_1","doi-asserted-by":"publisher","DOI":"10.3233\/NPM-16915122"},{"key":"e_1_2_7_40_1","first-page":"105","article-title":"The fetal circulation and its adjustments after birth in congenital heart disease","volume":"10","author":"Rudolph AM","year":"1970","journal-title":"UCLA Forum Med Sci"},{"key":"e_1_2_7_41_1","doi-asserted-by":"publisher","DOI":"10.1203\/00006450-197204000-00004"},{"key":"e_1_2_7_42_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.RES.65.1.127"},{"key":"e_1_2_7_43_1","first-page":"H80","article-title":"Control of fetal cardiac output during changes in blood volume","volume":"238","author":"Gilbert RD","year":"1980","journal-title":"Am J Physiol"},{"key":"e_1_2_7_44_1","first-page":"152","volume-title":"Fetal Cardiology: Embryology, Genetics, Physiology, Echocardiographic Evaluation, Diagnosis and Perinatal Management of Cardiac Diseases","author":"Baschat AA","year":"2009"},{"key":"e_1_2_7_45_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2012.06.005"},{"key":"e_1_2_7_46_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2014.06.012"},{"key":"e_1_2_7_47_1","doi-asserted-by":"publisher","DOI":"10.1113\/expphysiol.2009.049379"},{"key":"e_1_2_7_48_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.110.943431"},{"key":"e_1_2_7_49_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2261-9-1"},{"key":"e_1_2_7_50_1","doi-asserted-by":"publisher","DOI":"10.1152\/ajpregu.00484.2014"},{"key":"e_1_2_7_51_1","doi-asserted-by":"publisher","DOI":"10.1016\/B978-1-4160-2390-6.50042-8"},{"key":"e_1_2_7_52_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5223(03)00971-1"},{"key":"e_1_2_7_53_1","doi-asserted-by":"publisher","DOI":"10.1152\/ajpheart.01018.2013"},{"key":"e_1_2_7_54_1","doi-asserted-by":"publisher","DOI":"10.1536\/ihj.52.56"},{"key":"e_1_2_7_55_1","doi-asserted-by":"publisher","DOI":"10.1152\/ajpheart.00103.2015"},{"key":"e_1_2_7_56_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.08-0492"},{"key":"e_1_2_7_57_1","doi-asserted-by":"publisher","DOI":"10.1530\/JOE-15-0309"},{"key":"e_1_2_7_58_1","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.114.000858"},{"key":"e_1_2_7_59_1","first-page":"1244","article-title":"Right ventricle in congenital heart disease: is it just a \u201cweaker\u201d left ventricle?","volume":"99","author":"Mital S.","year":"2006","journal-title":"Arch Mal Coeur Vaiss"},{"key":"e_1_2_7_60_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0052125"},{"key":"e_1_2_7_61_1","first-page":"H657","article-title":"Fetal myocardial oxygen and carbohydrate consumption during acutely induced hypoxemia","volume":"242","author":"Fisher DJ","year":"1982","journal-title":"Am J Physiol"},{"key":"e_1_2_7_62_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1651-2227.2004.tb00233.x"},{"key":"e_1_2_7_63_1","doi-asserted-by":"publisher","DOI":"10.1038\/pr.2016.65"},{"key":"e_1_2_7_64_1","doi-asserted-by":"publisher","DOI":"10.1017\/S1047951113000978"}],"container-title":["Ultrasound in Obstetrics &amp; Gynecology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/uog.22164","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/uog.22164","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/uog.22164","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,25]],"date-time":"2023-08-25T23:25:38Z","timestamp":1693005938000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1002\/uog.22164"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,5]]},"references-count":63,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2021,5]]}},"alternative-id":["10.1002\/uog.22164"],"URL":"https:\/\/doi.org\/10.1002\/uog.22164","archive":["Portico"],"relation":{},"ISSN":["0960-7692","1469-0705"],"issn-type":[{"value":"0960-7692","type":"print"},{"value":"1469-0705","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,5]]},"assertion":[{"value":"2020-03-06","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-07-09","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-05-03","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}