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Decreasing Time Between Birth and BAS Improves Outcomes in Infants with d-TGA

 

Christopher L. Lindblade, MD


Christopher L. Lindblade, MD

Infants with dextro-transposition of the great arteries (d-TGA) are at high risk for hemodynamic compromise in the immediate postnatal period due to dependence on intracardiac mixing for oxygen delivery. Balloon atrial septostomy (BAS) is an established intervention that improves intracardiac mixing and perioperative hemodynamics. However, rapid performance of a BAS can be challenging when the pediatric cardiac center is not physically attached to the delivery hospital.   

This retrospective study, Prenatal Detection of D-TGA and Novel Interventional Program to Decrease Time to Balloon Septostomy, describes a novel interventional program for all prenatal d-TGA patients - coordinated care onsite at the delivery hospital. That is, a catheterization interventionalist and cardiac sonographer present in the delivery hospital NICU at the time of delivery rather than arranging for rapid transport to the pediatric cardiac center and delaying treatment.   

The time from birth to BAS was significantly shorter for patients in the interventional program group (1.1?h) compared to the rapid transport (4.5?h) and postnatal diagnosis groups (9.3?h, p value < 0.01).  The interventional program group also had lower lactate levels and less acidotic pH compared to the other groups.  Long-term follow-up is needed to determine if abating this initial period of hemodynamic instability will lead to improved neurodevelopmental outcomes.