Andersons pediatric cardiology 220
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FIG.8.16 Two-dimensionalimagingofafetuswithd-transpositionofthe
greatvessels.Notetheparallelarrangementofthegreatvessels.AO,
Aorta;LV,leftventricle;PA,pulmonaryartery;RV,rightventricle.See
Videos8.24through8.26.
PostnatalOutcomes
Asanesthesia,criticalcare,andcardiacsurgerycontinuetoimprove,ratesof
neonatalsurvivalforinfantsbornwithprenatallydiagnosedcongenitalcardiac
malformationshavesimilarlyimproved.Whetherprenataldiagnosisofthe
defectsaloneimprovesneonatalsurvivalremainscontroversial.Anumberof
studieshavefailedtodemonstrateadifferenceinneonatalsurvivalaftersurgical
repairamonginfantsdiagnosedprenatallycomparedwiththosediagnosed
postnatally,79–83althoughsomehavereportedimprovedsurvivalininfants
prenatallydiagnosedwithHLHS101andd-transpositionofthegreatvessels.94–97
Prenataldiagnosis,nonetheless,doesaffectmorbidity.Numerousstudieshave
demonstratedimprovedpreoperativeconditionsininfantsprenatallydiagnosed
withduct-dependentlesions,withthepotentialforbetterlong-term
neurodevelopmentaloutcomes.102–105Multiinstitutionalstudiesareneededto
assesstheeffectofprenataldiagnosisonlong-termneurodevelopmental
outcome.
AnnotatedReferences
BerningRA,SilvermanNH,VillegasM,etal.
Reversedshuntingacrosstheductusarteriosus
oratrialseptuminuteroheraldssevere
congenitalheartdisease.JAmCollCardiol.
1996;27:481–486.
Inthisstudy,reversedshuntingacrossthearterial
ductwasfoundtobeasensitive
echocardiographicmarkerforcriticalrightsidedobstructivedisease.Reversedshunting
acrosstheatrialseptumwasfoundtobea
sensitiveechocardiographicmarkerforcritical
left-sidedobstructivedisease.
ArduiniM,RosatiP,CaforioL,etal.Cerebral
bloodflowautoregulationandcongenitalheart
disease:possiblecausesofabnormalprenatal
neurologicdevelopment.JMaternFetal
NeonatalMed.2011;24:1208–1211.
DonofrioMT,Moon-GradyAJ,HornbergerLK,et
al.Diagnosisandtreatmentoffetalcardiac
disease:ascientificstatementfromthe
Americanheartassociation.Circulation.
2014;129:2183–2242.
Thisisacomprehensivescientificstatementfrom
theAmericanHeartAssociationregardingthe
