{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T15:51:58Z","timestamp":1791129118998,"version":"4.1.0"},"reference-count":26,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T00:00:00Z","timestamp":1772668800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T00:00:00Z","timestamp":1772668800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100005627","name":"Thrasher Research Fund","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100005627","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["SCA 145104"],"award-info":[{"award-number":["SCA 145104"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp; Gyne"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Newborns with dextro\u2010transposition of the great arteries (TGA) without adequate intracardiac shunting of oxygenated blood are at imminent risk of severe hypoxia at birth. Using fetal echocardiography and cardiac magnetic resonance imaging (CMR) in room air (RA) and during acute maternal hyperoxygenation (AMH), we sought to identify predelivery imaging features predictive of neonatal hypoxia and the need for urgent balloon atrial septostomy (BAS) within the first 3\u2009h after birth.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This was a prospective single\u2010center cohort study of pregnancies with TGA with an intact ventricular septum (IVS) or a single ventricular septal defect (VSD) \u2264\u20094\u2009mm. Fetal echocardiography and, if feasible, CMR were conducted concurrently at 34\u201338\u2009weeks' gestation. Cardiac structures, including the foramen ovale (FO) and atrial septum, were examined using two\u2010dimensional and Doppler echocardiography. CMR was used to quantify fetal weight, brain volume and vascular oxygen saturation (SaO\n                      <jats:sub>2<\/jats:sub>\n                      ). Both imaging modalities were used to assess fetal vascular blood flows in RA and during AMH. Postnatal data collected included preductal oxygen saturation (SpO\n                      <jats:sub>2<\/jats:sub>\n                      ) and the need for and timing of BAS. Univariable logistic regression analysis was used to evaluate associations between predelivery imaging features and the need for urgent neonatal BAS.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 34 newborns with TGA\/IVS (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200929) or TGA\/VSD (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20095), 23 (68%) underwent neonatal BAS, including 12 cases of urgent BAS &lt;\u20093\u2009h after birth for persistent preductal SpO\n                      <jats:sub>2<\/jats:sub>\n                      \u2009&lt;\u200970%. A fetal echocardiogram was obtained in all cases, while 26\/34 (76%) underwent CMR, including 9\/12 (75%) cases that underwent urgent BAS. On univariable logistic regression analysis, abnormal atrial septal flap morphology in RA (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.004), effective FO size \u2264\u20093.4\u2009mm during AMH (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.0024) and constricted or continuously reversed diastolic flow across the ductus arteriosus (DA) during AMH (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.0006) were the most significant predictors of urgent neonatal BAS. On CMR, fetuses with an ascending aorta (AAo)\/main pulmonary artery (MPA) SaO\n                      <jats:sub>2<\/jats:sub>\n                      ratio &gt;\u20091 during AMH were significantly more likely to undergo urgent BAS postnatally (odds ratio, 28.6 (95%\u2009CI, 1.1\u2013620.3);\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.0084).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      In fetuses with TGA, predelivery assessment of atrial septal morphology in RA, as well as effective FO size, DA flow pattern and AAo\/MPA SaO\n                      <jats:sub>2<\/jats:sub>\n                      ratio &gt;\u20091 during AMH, are the most useful variables for predicting the need for urgent neonatal BAS. \u00a9 2026 International Society of Ultrasound in Obstetrics and Gynecology.\n      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Toronto ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L.","family":"Sun","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children University of Toronto  Toronto ON Canada"},{"name":"Translational Medicine Research Program, SickKids Research Institute University of Toronto  Toronto ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5612-6070","authenticated-orcid":false,"given":"M.","family":"Saito","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children University of Toronto  Toronto ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Szabo","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children University of Toronto  Toronto ON 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