Cardiac hemodynamics in fetuses with transposition of the great arteries and intact ventricular septum from diagnosis to end of pregnancy: longitudinal follow‐up
Bibliographic record
Abstract
ABSTRACT Objectives Little is known about cardiac hemodynamics in the fetus with transposition of the great arteries and intact ventricular septum (TGA‐IVS). Better understanding of the fetal physiology in TGA‐IVS would help to provide insights into specific clinical complications observed after birth, in particular neonatal hypoxia and pulmonary hypertension. The aim of this study was to assess cardiac hemodynamics in fetuses with TGA‐IVS by performing systematic longitudinal echocardiographic follow‐up from diagnosis to delivery. Methods This was a longitudinal retrospective study of fetuses referred between 2010 and 2018 to the Sainte‐Justine University Hospital Centre. Complete assessment of cardiac hemodynamics was performed in fetuses with TGA‐IVS at 18–22, 28–32 and 35–38 weeks' gestation, which were compared with normal fetuses matched for gestational age. The maximum diameter of the foramen ovale was measured using two‐dimensional echocardiography under the guidance of color Doppler echocardiography. Fetal cardiac hemodynamics were analyzed according to postnatal preductal transcutaneous oxygen saturation (TcSO 2 ) < 65% or ≥ 65%, as a neonatal outcome, in fetuses with TGA‐IVS. Results In total, 59 fetuses with TGA‐IVS and 160 normal fetuses were included. Global cardiac output was significantly higher in fetuses with TGA‐IVS than in controls, mainly owing to higher global pulmonary output, while global systemic cardiac output did not differ between TGA‐IVS fetuses and controls throughout pregnancy. Aortic flow (right ventricular output in fetuses with TGA‐IVS, left ventricular output in controls) was significantly higher in fetuses with TGA‐IVS than in normal fetuses. Ductal flow was significantly lower in fetuses with TGA‐IVS at every timepoint, and this difference increased considerably after 28–32 weeks. In parallel, the diameter of the foramen ovale was significantly smaller in fetuses with TGA‐IVS at 28–32 and 35–38 weeks, with a stagnation in growth after 28 weeks, compared with continuous growth in normal fetuses. Most of these cardiac hemodynamic anomalies in fetuses with TGA‐IVS were already present at 18–22 weeks, and the differences became greater at 28–32 weeks' gestation. TGA‐IVS neonates with TcSO 2 < 65% had lower fetal left ventricular output, higher diastolic ductal retrograde flow and smaller foramen ovale at 28–32 weeks, compared with fetal values in those with postnatal TcSO 2 ≥ 65%. Conclusions Compared with normal fetuses, those with TGA‐IVS undergo a complex redistribution of blood flow during the second half of pregnancy, with higher global pulmonary flow, lower ductal flow (with negative diastolic flow at the end of pregnancy) and a smaller foramen ovale. In addition, fetal cardiac hemodynamic anomalies observed at 28–32 weeks' gestation were associated with lower postnatal TcSO 2 . These observations may provide a better understanding of premature closure of the foramen ovale and postnatal hypoxia that are specific to TGA‐IVS physiology. © 2019 International Society of Ultrasound in Obstetrics and Gynecology
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".