Perinatal Management And Surgery Of Transposition Of The Great Arteries

Objective:By analyzing the relevant data of the diagnosis and treatment of transposition of the great arteries,to improve the cognition of this disease,strengthen the management during pregnancy?neonatal and preoperative period,and improve their survival rate.At the same time,we can realize its surgical treatment and prognosis,so as to provide data support for the reasonable management of fetal transposition of the great arteries in perinatal period.Methods:In this article,168 pregnant women diagnosed with transposition of the great arteries are enrolled from 2006 to 2018 in the Department of Obstetrics and Gynecology Hospital of Zhejiang University School of Medicine,and relevant date are collated from following aspects:their diagnostic gestational age,chromosome examination,the gestational age of termination of pregnancy,delivery mode,fetal condition after delivery and their management,operative time and its prognosis and so on.Results:In this study,85.2%of the cases were detected by fetal ultrasound at 20-26 weeks of gestation.72.6%were associated with one or more heart or other malformations.46 pregnant women were followed up to deliver the fetus.The average gestational weeks of delivery:37.63±2.45 weeks;delivery mode:50%vaginal birth,45.7%cesarean section,4.3%forceps delivery.Average birth weight of the fetus:3082.1 ± 674.9g,and most fetuses are born between the 10th and 90th percentile of weight at the same gestational week.Various degree of hypoxemia may occur after delivery,and different treatments are performed based on its symptoms.In these patients received surgical treatment finally(31 cases),the timing of surgery ranged from 0 days to 1 month postpartum,with a median of 7 days and an average of 9.8±8.0 days.For children with intact ventricular septum and ventricular septum defect,the median operation time was 7 days and 8 days respectively,with an average of 7.3 ± 4.1 days and 13.5 ± 10.7 days,but the difference was not statistically significant(P=0.39).The postoperative mortality of these patients was 16.1%,and 71%have a good prognosis at present.None of the 3 children with corrected transposition of the great arteries received surgical treatment,and their prognosis are good at present.CONCLUSION:Transposition of the great arteries can be detected by ultrasound in the second trimester and are often associated with one or more heart or other malformations.If there is no other complicated complex abnormalities,pregnancy can be continued.Pregnant women can choose vaginal delivery if there is no contraindication,and there is no need to grve birth in advance.The treatment of TGA after delivery and the timing of operation should be individualized.High risk factors for postoperative death included preterm delivery and low birth weight,combined ventricular septal defect,surgical timing,postoperative cardiac insufficiency,delayed sternal closure and so on.In follow-up,surgical treatment has a good prognosis at present.