BEDSIDE BALLOON ATRIAL SEPTOSTOMY ON TRANSPOSITION OF GREAT ARTERIES WITH INTACT VENTRICULAR SEPTUM
Sardito Phan,Jessica Christy Limanjaya,Dedi Wilson MCH Puar,Markus Mualim Danusantoso
RSIA Bunda Jakarta
Background : Transposition of Great Arteries (TGA) is one of the critical congenital heart disease in newborn. It is one of the cyanotic heart disease group. Inadequate mixing either through Patent Foramen Ovale (PFO) in the atrium or through Patent Ductus Arteriosus (PDA) can lead to death. Urgent Balloon Atrial Septostomy (BAS) guided by echocardiography can be a temporary life saving procedure while waiting for arterial switch surgery in cardiology center.
Case Presentation Summary : A baby was born at term by caesarean section, birth weight 2890 grams, uneventful. Baby was stable at birth and transported to the perinatology unit. During observation, oxygen saturation was dropped to 78%, pO2 was 28.9 mmHg. Subsequent developed tachypnea and tachycardia and did not respond to oxygen support. On echocardiography was found TGA with intact ventricle septum, 1 milimeter PDA with bidirectional shunt dominant left to right shunt, PFO with bidirectional shunt. Baby was transported to NICU, Intubated, intravenous prostalglandin E2 was given 10 nanograms/KgBW/minute to maintain oxygen saturation. Bedside BAS was performed in the Nenatal Intensive Care Unit (NICU) with echocardiography guiding for emergency life saving while being prepared for arterial switch surgery. Created Atrial Septal Defect (ASD) was 4.88 milimeters, pO2 achieved 80 mmHg, and oxygen saturation achieved 85-90%.
Learning Points/Discussion : TGA is a critical newborn condition, which survival is depends on arterial switching to support the systemic oxygenation. Delayed time for arterial switch surgery at cardiology referral center can increase the mortality rate of babies born with TGA. Cardiology referral center may not be always available and babies with TGA may need a temporary life saving intervention. Bedside BAS can be a palliative procedure for babies with TGA and can be done with echocardiography guiding at the NICU. It’s success is proved by the increase of oxygen saturation and pO2 measured.
Keywords: transposition of great arteries TGA balloon atrial septostomy BAS neonatal intensive care unit NICU congenital heart disease
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