Abstract
Catheterization and Rashkind BAS is “routine” management in reported series of neonates prior to arterial switch repair of TGA. From 8/86-2/90, we treated 15 newborns with TGA, birth weiqht 3.3kq(range 2.7-4.3). All received PGE-1; 2-D echo, Doopler, color flow included assessment of foramen ovale(FO), ductus arteriosus(DA) and coronary anomaly(Co-Anom). The FO was defined “restrictive”(“R”FO) by echo grading of septal L-R bowing, diameter FO and flow velocity(Table). All had switch under deep hypothermia, cardiopulmonary by-pass and circulatory arrest.
Only 3 required cardiac cath and BAS(ages 10hr, 16hr, 270hr). All 15 had PDA after PGE, but these 3 did not have acceptable pO2 rise (Table). Only these 3 had “R”FO by echo and O2 increased after BAS (n pO2 29→43 torr). The 1 Co-Anom was correctly predicted by echo. Fourteen(93%) survive to date(2mo-3.5yr) and are NYHA-I. The non-survivor had BAS but died 2 days post switch. Conclusion: Clinical and echo criteria accurately identify newborns requiring BAS. Routine cath and BAS are not necessary for successful arterial switch when undertaken early in newborns with acceptable pO2 and non “R”FO.
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Baylen, B., Grzeszczak, M., Gleason, M. et al. 113 RASHKIND BALLOON ATRIAL SEPTOSTOMY(BAS) FOR CYANOTIC TRANSPOSITION OF THE GREAT ARTERIES(TGA). IS IT ALWAYS NECESSARY?. Pediatr Res 28, 296 (1990). https://doi.org/10.1203/00006450-199009000-00137
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DOI: https://doi.org/10.1203/00006450-199009000-00137