Echocardiography guided bed side balloon atrial septostomy in dextro transposed great arteries (dTGA) with intact ventricular septum (IVS): A resource limited country experience

Abstract

Objective:To determine effectiveness and safety of echocardiography guided bed side Balloon Atrial Septostomy (BAS) in dextro transposition of great Arteries (dTGA) with intact ventricular septum (IVS) at a public sector tertiary care hospital Karachi, Pakistan.Methods:This case series include 40 patients with echocardiographic findings of dTGA with IVS and restricted PFO (≤ 2mm) who underwent bedside BAS at department of pediatric cardiology NICVD, Karachi, Pakistan. We recorded pre and post BAS diameter of PFO/Atrial Septal Defect (ASD), oxygen saturation (SpO2 %), and post procedure complications and outcome.Results:Median age was 16 days, Majority of them (n=23, 58%) were severely cyanosed with SpO2 of 41.4±3.4% and underwent emergency BAS and remaining underwent elective procedure. An increase in SpO2% from 46.0±6% to 81.0±3.0% (p=<0.001) and ASD size from 1.4±2.8mm to 5.45±0.4mm was observed (p=<0.001). No complication was observed in most of cases (n=28, 70%). Mean hospital stay was 3.4±1 days. Success rate was 97.5% however, one neonate died due to neonatal sepsis.Conclusion:Our study provides sufficient evidence that bed side balloon atrial septostomy is a safer technique, save a lot of time and resources which were required otherwise in transporting these patients to catheterization laboratory.

Balloon atrial septostomy for transposition of the great arteries: Safety and experience with the Z‐5 balloon catheter

“…Registered complications were of mechanical (e.g., balloon rupture), traumatic (e.g., cardiac damage), embolic (e.g., cerebral event), and electrophysiological (e.g., transient rhythm disorders or AV‐block) nature and were reported for all catheters. The Fogarty and Miller‐Edwards balloon catheters were related with an increased frequency of balloon ruptures, whereas the Z‐5 and Rashkind catheters were not associated with this problem 5,12–14 …”

Interventional Treatment of Cardiac Emergencies in Children with Congenital Heart Diseases

“…However, a number of complications have been reported as associated with this maneuver including balloon rupture with consequent embolization, air embolism, cardiac damage with rupture of the atrial appendage, mitral valve injury, vascular injury (of the pulmonary veins or the inferior vena cava), or thrombosis of the umbilical vein. [5][6][7][8][9][10][11][12][13][14]…”

Stents as Bridge to Arterial Switch Operation for D-Transposition of Great Arteries Late Presenter

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