Clinical effects of persistent pulmonary hypertension in newborns diagnosed with transposition of the great arteries

Abstract

Introduction Transposition of the great arteries (TGA) is one of the critical congenital heart diseases of the newborn. The transition from fetal to postnatal circulation in these infants is complex, and the presence of persistent pulmonary hypertension of the newborn (PPHN) during this period may affect surgical outcomes. This study aims to evaluate the impact of PPHN on perioperative morbidity and mortality in infants with TGA. Materials and methods The study was conducted between December 1, 2024, and December 1, 2025, in two high-volume cardiac centers, involving newborns diagnosed with TGA. Patients were divided into two groups—PPHN and non-PPHN—based on clinical and echocardiographic findings. The groups were evaluated for early-term (first 30 days) mortality and morbidity. Findings were analyzed statistically. Results A total of 48 newborns with TGA (60% male) were included. The median age at operation was 5 days (IQR 3–7), median weight was 3,100 g (IQR 2,900–3,400), and the median preoperative oxygen saturation was 76% (IQR 70–82). Balloon atrial septostomy was performed in eight infants prior to ASO. PPHN was identified in thirteen infants (27%). Postoperative complication rates—including duration of vasopressor use, duration of sedative medication, length of hospital stay, and duration of mechanical ventilation—were higher in the PPHN group (p < 0.05). Overall mortality was 10.4%, with no significant difference between the PPHN and non-PPHN groups (15.3% vs. 8.5%; p = 0.60). Conclusion In newborns with TGA, PPHN was associated with increased postoperative morbidity. While no statistically significant difference in early mortality was observed, larger multicenter studies are needed to better define the impact of PPHN on mortality risk.