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A ventricular septal defect (VSD) is thought to be an additional risk factor for adverse neurodevelopment, but literature describing this population is sparse. The objectives of this study were to assess fetal cardiac hemodynamics throughout pregnancy, to monitor cerebral hemodynamics and oxygen metabolism in neonates, and to compare these data between patients with TGA\u2010IVS, those with TGA\u2010VSD and age\u2010matched controls.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Cardiac hemodynamics were assessed in TGA\u2010IVS and TGA\u2010VSD fetuses and compared with healthy controls matched for gestational age (GA) during three periods: \u2264\u200922\u2009+\u20095\u2009weeks (GA1), 27\u2009+\u20090 to 32\u2009+\u20095\u2009weeks (GA2) and \u2265\u200934\u2009+\u20095\u2009weeks (GA3). Left (LVO), right (RVO) and combined (CVO) ventricular outputs, ductus arteriosus flow (DAF, sum of ante\u2010 and retrograde flow in systole and diastole), diastolic DAF, transpulmonary flow (TPF) and foramen ovale diameter were measured. Aortic (AoF) and main pulmonary artery (MPAF) flows were derived as a percentage of CVO. Fetal middle cerebral artery and umbilical artery (UA) pulsatility indices (PI) were measured and the cerebroplacental ratio (CPR) was derived. Bedside optical brain monitoring was used to measure cerebral hemoglobin oxygen saturation (SO<jats:sub>2<\/jats:sub>) and an index of microvascular cerebral blood flow (CBF<jats:sub>i<\/jats:sub>), along with peripheral arterial oxygen saturation (SpO<jats:sub>2<\/jats:sub>), in TGA\u2010IVS and TGA\u2010VSD neonates. Using hemoglobin (Hb) concentration measurements, these parameters were used to derive cerebral oxygen delivery and extraction fraction (OEF), as well as an index of cerebral oxygen metabolism (CMRO<jats:sub>2i<\/jats:sub>). These data were acquired in the early preoperative period (within 3\u2009days after birth and following balloon atrial septostomy) and compared with those of age\u2010matched healthy controls, and repeat measurements were collected before discharge when vital signs were stable.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>LVO was increased in both TGA groups compared with controls throughout pregnancy. Compared with controls, TPF was increased and diastolic DAF was decreased in TGA\u2010IVS fetuses throughout pregnancy, but only during GA1 and GA2 in TGA\u2010VSD fetuses. Compared with controls, DAF was decreased in TGA\u2010IVS fetuses throughout pregnancy and in TGA\u2010VSD fetuses at GA2 and GA3. At GA2, AoF was higher in TGA\u2010IVS and TGA\u2010VSD fetuses than in controls, while MPAF was lower. At GA3, RVO and CVO were higher in the TGA\u2010IVS group than in the TGA\u2010VSD group. In addition, UA\u2010PI was lower at GA2 and CPR higher at GA3 in TGA\u2010VSD fetuses compared with TGA\u2010IVS fetuses. Within 3\u2009days after birth, SpO<jats:sub>2<\/jats:sub> and SO<jats:sub>2<\/jats:sub> were lower in both TGA groups than in controls, while Hb, cerebral OEF and CMRO<jats:sub>2i<\/jats:sub> were higher. Preoperative SpO<jats:sub>2<\/jats:sub> was also lower in TGA\u2010VSD neonates than in those with TGA\u2010IVS. From preoperative to predischarge periods, SpO<jats:sub>2<\/jats:sub> and OEF increased in both TGA groups, but CBF<jats:sub>i<\/jats:sub> and CMRO<jats:sub>2i<\/jats:sub> increased only in the TGA\u2010VSD group. During the predischarge period, SO<jats:sub>2<\/jats:sub> was higher in TGA\u2010IVS than in TGA\u2010VSD neonates, while CBF<jats:sub>i<\/jats:sub> was lower.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Fetal cardiac and neonatal cerebral hemodynamic\/metabolic differences were observed in both TGA groups compared with controls. Compared to those with TGA\u2010IVS, fetuses with TGA\u2010VSD had lower RVO and CVO in late gestation. A higher level of preoperative hypoxemia was observed in the TGA\u2010VSD group. Postsurgical cerebral adaptive mechanisms probably differ between TGA groups. Patients with TGA\u2010VSD have a specific physiology that warrants further study to improve neonatal care and neurodevelopmental outcome. \u00a9 2022 International Society of Ultrasound in Obstetrics and Gynecology.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.26146","type":"journal-article","created":{"date-parts":[[2022,12,24]],"date-time":"2022-12-24T17:17:55Z","timestamp":1671902275000},"page":"346-355","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Fetal cardiac and neonatal cerebral hemodynamics and oxygen metabolism in transposition of the great arteries"],"prefix":"10.1002","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9371-6619","authenticated-orcid":false,"given":"L.","family":"Charbonneau","sequence":"first","affiliation":[{"name":"Research Centre CHU Sainte\u2010Justine Hospital University Centre  Montreal Quebec Canada"},{"name":"Department of Biomedical Sciences University of Montreal  Montreal Quebec Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R. A.","family":"Chowdhury","sequence":"additional","affiliation":[{"name":"Research Centre CHU Sainte\u2010Justine Hospital University Centre  Montreal Quebec Canada"},{"name":"Institute of Biomedical Engineering University of Montreal  Montreal Quebec Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"B.","family":"Marandyuk","sequence":"additional","affiliation":[{"name":"Research Centre CHU Sainte\u2010Justine Hospital University Centre  Montreal Quebec Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R.","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Fetal Cardiology CHU Sainte\u2010Justine Hospital University Centre  Montreal Quebec Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"N.","family":"Poirier","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery University of Montreal  Montreal Quebec Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J.","family":"Mir\u00f3","sequence":"additional","affiliation":[{"name":"Department of Fetal Cardiology CHU Sainte\u2010Justine Hospital University Centre  Montreal Quebec Canada"},{"name":"Division of Pediatric Cardiology University of Montreal  Montreal Quebec Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A.\u2010M.","family":"Nuyt","sequence":"additional","affiliation":[{"name":"Research Centre CHU Sainte\u2010Justine Hospital University Centre  Montreal Quebec Canada"},{"name":"Division of Neonatology, Department of Pediatrics University of Montreal  Montreal Quebec Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M.\u2010J.","family":"Raboisson","sequence":"additional","affiliation":[{"name":"Department of Fetal Cardiology CHU Sainte\u2010Justine Hospital University Centre  Montreal Quebec Canada"},{"name":"Division of Pediatric Cardiology University of Montreal  Montreal Quebec Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9852-6761","authenticated-orcid":false,"given":"M.","family":"Dehaes","sequence":"additional","affiliation":[{"name":"Research Centre CHU Sainte\u2010Justine Hospital University Centre  Montreal Quebec Canada"},{"name":"Institute of Biomedical Engineering University of Montreal  Montreal Quebec Canada"},{"name":"Department of Radiology, Radio\u2010oncology and Nuclear Medicine University of Montreal  Montreal Quebec Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,3]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(02)01886-7"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cjca.2017.09.020"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0b013e318265ee8a"},{"key":"e_1_2_8_5_1","first-page":"106","article-title":"The transition from fetal to neonatal circulation: normal responses and implications for infants with heart disease","volume":"17","author":"Friedman AH","year":"1993","journal-title":"Semin Perinatol"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-2007-1020009"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5223(03)00711-6"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199310073291501"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.111.026963"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.118.037495"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1067\/mtc.2002.122307"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.21920"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.23707"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.17370"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2019.08.045"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2018.04.098"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1186\/1532-429X-18-S1-P156"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1364\/BOE.8.003993"},{"key":"e_1_2_8_19_1","doi-asserted-by":"crossref","unstructured":"BuckleyEM CarpS LinI NakajiH DubbJ HeuberD DehaesM GrantE BoasD FranceschiniMA.A Novel Combined Frequency\u2010Domain Near\u2010Infrared Spectroscopy and Diffuse Correlation Spectroscopy System.Biomedical Optics2014. 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