Role of balloons atrial septostomy in infants with transposition of the great arteries older than one month

ABSTRACT

Balloon atrial septostomy [BAS] is the initial line in management of severely hypoxic neonates with transposition of the great arteries [TGA] and is almost always successful in tearing the septum primum in the first 2 weeks of life. Moreover, it is only occasionally successful after the first month of life because the valve of the foramen oval becomes thicker. In Egypt, a large number of cases of TGA come to medical attention older than one month of age, where ideally BAS should be ineffective, and thus this study was done to evaluate its role in such cases. Twelve infants above one month of age with TGA were included in the study. The diagnosis was established by echocardiography and was confined by cardiac catheterization and angiography just before performing BAS. There were 8 males and 4 females. Their ages, at the time of BAS, ranged from 40 days to 64 days with a mean of 51.4 days. Their weights ranged from 3.5 kg to 6 kg with a mean of 4.75 kg. The mean aortic saturation increased by 22% and the average mean pressure gradient between both atria became 0.4 mmHg, following BAS, and cyanosis was clinically decreased. Doppler echocardiography, performed the next day in 9 infants, showed an atrial septal defect with free flapping of the inferior portion of the atrial septum, with increased left-to- right shunting across it. Three infants died after the procedure. Thus, BAS appears to be still effective in infants older than one month of age with TGA and should be offered to them as an initial palliative procedure