Left ventricular regression after balloon atrial septostomy in d-transposition of the great arteries

Abstract

BAS is associated with accelerated regression of the LV in infants with simple d-transposition of the great arteries in the first 2 weeks after the procedure. Regression of the LV is faster in children who underwent BAS after 3 weeks of age.

Ductal Stenting to Retrain the Involuted Left Ventricle in d-Transposition of the Great Arteries

“…A large interatrial shunt diverts flow away from the LV and hence prevents effective volume loading of the LV. In the same vein, Gopalakrishnan and colleagues [5] demonstrated that the presence of an interatrial communication is associated with accelerated regression of the LV. In our cohort, an ASD-to-interatrial septal length ratio of more than 0.38 was associated with higher risk of failed LV retraining.…”

“…LV was derived using the dimensions obtained from the parasternal long-axis view in end-diastole where LV where LVID is the LV internal diameter in diastole, IVSd is the interventricular septal thickness, PWd is the LV posterior wall thickness in diastole [4], 1.04 is the specific gravity of the myocardium, and 0.8 is the correction factor. LV mass was indexed to body surface area using the Mosteller formula [5]. LV volumes and volumes were derived from LV dimensions.…”

Ductal Stenting and Judicious Avoidance of Septostomy Rapidly Retrain a Regressed Left Ventricle in D Transposition: A Case Report

“…Furthermore so since increasing the ASD/IAS ratio (0.18) might hinder successful LV retraining. 2) 3) …”

Balloon atrial septostomy at the bedside versus the catheterisation laboratory

“…In the developing world, we get several referrals of transposition beyond the first week of life where the umbilical access is unavailable. 2 Although we fully accept the virtues of an echocardiography-guided procedure by a paediatric cardiologist as opposed to a purely fluoroscopy-guided balloon atrial septostomy, doubts remain on the ideal choice of access for a bedside procedure. This is particularly relevant in the setting where atrial septostomy is considered primarily as a mode of stabilisation at a referring hospital before transport to a tertiary paediatric cardiac facility.…”

“…It would be ideal for the authors to detail whether the post-procedure care differed in either arm with respect to stay in the intensive care, necrotising enterocolitis, and resumption of feeds, particularly with an umbilical access. In the developing world, we get several referrals of transposition beyond the first week of life where the umbilical access is unavailable 2 . Although we fully accept the virtues of an echocardiography-guided procedure by a paediatric cardiologist as opposed to a purely fluoroscopy-guided balloon atrial septostomy, doubts remain on the ideal choice of access for a bedside procedure.…”