Echocardiography guided bed side balloon atrial septostomy in dextro transposed great arteries (dTGA) with intact ventricular septum (IVS): A resource limited country experience

Naresh Kumar, Abdul Sattar Shaikh, Veena Kumari, Najma Patel, Naresh Kumar, Abdul Sattar Shaikh, Veena Kumari, Najma Patel

Abstract

Objective: To determine effectiveness and safety of echocardiography guided bed side Balloon Atrial Septostomy (BAS) in dextro transposition of great Arteries (dTGA) with intact ventricular septum (IVS) at a public sector tertiary care hospital Karachi, Pakistan.

Methods: This case series include 40 patients with echocardiographic findings of dTGA with IVS and restricted PFO (≤ 2mm) who underwent bedside BAS at department of pediatric cardiology NICVD, Karachi, Pakistan. We recorded pre and post BAS diameter of PFO/Atrial Septal Defect (ASD), oxygen saturation (SpO2 %), and post procedure complications and outcome.

Results: Median age was 16 days, Majority of them (n=23, 58%) were severely cyanosed with SpO2 of 41.4±3.4% and underwent emergency BAS and remaining underwent elective procedure. An increase in SpO2% from 46.0±6% to 81.0±3.0% (p=<0.001) and ASD size from 1.4±2.8mm to 5.45±0.4mm was observed (p=<0.001). No complication was observed in most of cases (n=28, 70%). Mean hospital stay was 3.4±1 days. Success rate was 97.5% however, one neonate died due to neonatal sepsis.

Conclusion: Our study provides sufficient evidence that bed side balloon atrial septostomy is a safer technique, save a lot of time and resources which were required otherwise in transporting these patients to catheterization laboratory.

Keywords: Atrial Septal Defect (ASD); Balloon Atrial Septostomy (BAS); Congenital heart diseases (CHD); Intact Ventricular Septum (IVS); Patent Foramen Ovale (PFO); dextro Transposition of Great Arteries (d-TGA).

Figures

Fig.1a
Fig.1a
Sub costal four chamber view showing small restrictive PFO.
Fig.1b
Fig.1b
Sub costal bicaval view showing guide wire course from ICV to RA.
Fig.1c
Fig.1c
Sub costal modified four chamber view showing balloon catheter course from RA to LA.
Fig.1d
Fig.1d
Sub costal modified four chamber view showing adequate sized created ASD after BAS.
Fig.2
Fig.2
Oxygen Saturation level.
Fig.3
Fig.3
Created Atrial Septal Defect Size.
Fig.4
Fig.4
Age (days) vs. Number of Tractions.

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