Impact of balloon atrial septostomy in neonates with transposition of great arteries

Abstract

Objective: To examine the impact of balloon atrial septostomy (BAS) on cardio-respiratory status, need for prostaglandin E 1 (PGE 1 ) and postoperative outcomes in infants with transposition of great arteries (TGA).Study Design: Single-center retrospective review of consecutive neonates with dTGA.Result: BAS was performed in 42 (70%) infants and resulted in a significant increase in minimum (61 to 76%) and maximum (80 to 90%) oxygen (O 2 ) saturations and a drop in FiO 2 . BAS was 'successful,' that is, PGE 1 was discontinued in 16 (38%) infants. Three infants died; four infants developed strokes, all of whom had undergone BAS. The duration of hospitalization, ventilation and O 2 need did not differ between infants without BAS, 'successful' BAS and unsuccessful BAS. PGE 1 duration correlated with duration of hospitalization, ventilation, O 2 need and peak respiratory severity score (P<0.03). Conclusion:We speculate that limiting BAS for clinical hypoxemia and aggressive weaning of PGE 1 following BAS would improve outcomes.

No difference found in safety or efficacy of balloon atrial septostomy performed at the bedside versus the catheterisation laboratory

“…1 Balloon atrial septostomy improves cerebral oxygenation and reduces oxygen requirements, 1,2 and it lowers in-hospital mortality relative to patients who do not undergo atrial septostomy. 3 Balloon atrial septostomy can be performed in the cardiac catheterisation laboratory using fluoroscopy, with or without ultrasound assistance, or at the patient's bedside using echocardiographic guidance alone. [4][5][6][7] The decision regarding where to perform the septostomy is often based on physician or institutional preference, with safety concerns or desire to visualise coronary artery anatomy often cited when the catheterisation laboratory is preferred.…”

What Interventional Cardiologists Are Still Leaving to the Surgeons?

“…Over 50 years, BAS has been stabilizing hypercyanotic transposition of TGA babies prior to corrective surgical repair. However, from recent publications, 43–62% of the cases cannot discontinue prostaglandin E1 after the successful BAS ( 16 – 18 ). Apart from enhancing the oxygenated–deoxygenated blood mixture, BAS remains indicate to augment cardiac output in patients with the right or left heart obstructions (e.g., tricuspid atresia, pulmonary valve atresia associated with RV coronary dependent circulation, mitral atresia, aortic atresia).…”

“…Since the first report of transcatheter closure 50 years ago, currently, transcatheter PDA closure has become a widely accepted procedure worldwide with comparable results to surgical therapy ( 20 , 21 ). Major adverse events of transcatheter PDA occlusion (i.e., device embolization, hemolysis, and obstruction of the left pulmonary artery/aortic isthmus) can occur with incidence of 0.6–83.3% depending upon the selected device ( 18 , 19 ). It is indicated for a symptomatic moderate to large PDA with left-to-right shunt or previously known occurrence of endocarditis.…”

Seltene Befunde und Diagnosen der Pränatalmedizin

“…Bei der Atrioseptostomie wird im Rahmen einer Herzkatheteruntersuchung unter radiologischer oder echokardiographischer Kontrolle auf der Intensivstation mittels eines Ballons das Septum auf Vorhofebene eingerissen, sodass es zu einem dauerhaften Rechts-links-Shunt kommt [15].…”