G161 Transposition of great arteries, a 15 year experience of 74 patients in wales: incorporation of outflow tract view in the antenatal scans leading to better antenatal detection and clinical outcomes

Abstract

Background Antenatal detection rate of transposition of the great arteries (TGA) has remained very low around 25% in the UK. This may have improved with the addition of outflow tract view to the routine 20 week foetal anomaly screening protocols with better overall outcomes. Patients and methods All children who were diagnosed with simple TGA at our centre for Paediatric Cardiology over a 15 year period were included in this study. Clinical case notes were retrospectively reviewed and outcome data was evaluated. Results There were 74 patients; 54 diagnosed postnatally, 20 antenatally. All 8 preterm deliveries were in postnatally diagnosed group. 32 had simple TGA and 42 had additional defects. Male: female ratio was 3.5:1. Antenatal detection rate improved from 0–20% to 75% in the recent years. 40% of cases diagnosed postnatally were unwell at presentation and most of them needed ventilatory support. Majority of the patients in our cohort needed prostin infusion following delivery and 60% of them underwent balloon septostomy before arterial switch operation was performed. Only one out of 74 patients had Mustard’s operation in our series. Postoperative complications were more common in postnatally diagnosed patients (26% vs 10%). There were no deaths in the antenatally detected group. Early mortality rate was 6.8% and operative mortality was 1.4% with no postoperative deaths being recorded after 2007. Echo abnormalities were seen in 83% at 2 years and 91% at 10 years follow up with neo aortic regurgitation being the commonest. Intervention free survival was 96%. 7% were on medications mainly due to impaired LV function. Growth and development issues, exercise intolerance and arrhythmias were uncommon in our series. Survival rate at 5 years was 88.1%. Conclusion Inclusion of outflow tract view has led to substantial improvement in antenatal detection of TGA. This, in turn, has made a major impact on the clinical outcomes owing to better cardiovascular status at presentation, lower postoperative complications and reduced mortality rates.