ultrasound diagnosis of fatal anomalies

THE HEART
Fig. 5.28 Transposition of the great arteries.
Parallel course of the outgoing vessels in right-sided
TGA (dextro-TGA). The aorta is coursing on the right.
R: right, L: left.
Fig. 5.29 Transposition of the great arteries. The
outflow tract of the heart at 21+5weeks,shown
using color flow mapping. The outflowing vessels do
not cross, but run parallel to each other. (Ao: aorta,
Pu: pulmonaryartery.)
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frequently also ASD are present. If a VSD is found,
there is stenosis of the pulmonary artery in 35%
of the cases.
Clinical management: Further sonographic
screening. Karyotyping, regular ultrasound
checks (if there is an obstruction of the outflow
tracts, cardiac failure may develop). Vaginal
delivery is possible.
Procedure after birth: This anomaly causes cyanosis.
Prostaglandin is administered to keep the
ductus arteriosus open; oxygen therapy should
not exceed 40–60% in this case. If the oval foramen
is constricted, widening of the atrial septum
using a balloon catheter may be necessary
prior to surgery. Surgical procedures such as the
arterial switch operation are possible in the first
2 weeks of life.
Prognosis: The long-term prognosis after surgical
correction is good. The mortality rate associated
with the switch operation is 5% in the
absence of other cardiac malformations.
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