0244 : Impact of balloon atrial septostomy guided by echocardiography in neonates with transposition of the great arteries

Abstract

Rashkind balloon atrial septostomy (BAS) is an effective palliative procedure aimed at improving systemic oxygenation by creating an atrial septal defect in newborns with transposition of the great arteries. It is an emergency intervention, allowing the planning for surgery. The aim of the study was to assess the results of the bedside balloon septostomy and to examine the impact on cardio-respiratory status in cyanotic neonates. We conducted a retrospective study on patients who underwent Rashkind procedure performed at the bedside at the neonatal intensive care unit of the CHU of Casablanca, between January 2013 and August 2015. Oxygen saturation, defect diameter and complication related to the procedure were evaluated. We excluded patients who had other major extra-cardiac congenital malformations. Ten atrioseptostomies by balloon catheter guided by echocardiography were carried out. BAS was performed successfully via the femoral vein in all cases. There was a predominance of the male sex (60%), the mean age was 25 days (5 to 75 days) and the mean weight was 3833 g. When comparing the average level of saturation pre and post-procedure (55% and 85.8%) and the average diameter of the interatrial septal defect pre and post-procedure (2.2 mm and 8 mm), there was a statistically significant difference. In all cases balloon septostomy was completed without complication. There was 1 death prior to surgery and 2 post-operative deaths accounting for a total mortality of 30 per cent. BAS guided by the echocardiography in the neonatal intensive care unit improve the survival of infants with complete transposition. Such infants can receive effective palliation without delay and without the full facilities required for cardiac catheterization. The author hereby declares no conflict of interest