A Retrospective Observational Study in Neonates with Transposition of Great Arteries Undergoing Balloon Atrial Septostomy in a Tertiary Care Hospital

Abstract

Transposition of great arteries (TGA) is a common cause of cyanotic newborns. There is an atrioventricular concordance with ventriculoarterial discordance. This parallel circulation is incompatible with life unless communication exists for the inter-circulatory mixing of blood. Balloon atrial septostomy (BAS) is a percutaneously performed interventional procedure in catheterization laboratory, usually in patients with TGA-intact ventricular septum (IVS) to ensure admixture of oxygenated and deoxygenated blood thus improving systemic oxygen delivery, to achieve hemodynamic stability before the definitive procedure (Arterial switch operation), and to determine the risk of intraprocedural complications in neonates undergoing balloon atrial septostomy. This is a retrospective observational study, which included neonatal patients during a single year. All the data were collected from the medical record section of the hospital. We included 17 neonates with TGA transferred to our center for definite treatment. Six cases were done under sedation and 11 under general anesthesia. The mean age at the time of BAS was 4.8 days. Procedure-related complications occurred in 41% of patients. In one of the cases, difficult airway management made the periprocedural course daunting. Complications included intraprocedural balloon rupture (1 case), transient atrial arrhythmia (4 cases), hypotension (1 case), and pericardial tamponade due to left atrial wall puncture (1 case). BAS is a safe and effective palliative procedure for TGA-IVS, with good immediate results in our institution. Maintaining cardiorespiratory stability, prevention of respiratory depression in a spontaneously breathing neonate, and maintenance of normothermia in the cold temperature of the catheterization laboratory, with eternal vigilance, forms the cornerstone of a successful neonatal outcome.