Use of umbilical venous catheter before performing Rashkind's procedure

Abstract

MOTS CLES Cardiopathie congenitale ; Echocardiographie ; Catheterisme cardiaque ; Transposition des gros vaisseaux A full-term newborn was referred to our paediatric intensive care unit for persistent cyanosis. There was no dyspnoea and cardiac auscultation was normal. Chest radiography showed a heart of normal size with pulmonary vascular overload. No improvement in capillary saturation was observed after a hyperoxia test, suggesting cyanotic congenital heart disease. An umbilical venous catheter was then placed in order to administrate intravenous prostaglandin therapy, and capillary saturation increased from 56 to 83%. Afterwards, the patient was transferred to our hospital to perform echocardiography and to continue care. Two-dimensional (2D) echocardiography revealed a transposition of the great arteries (Fig. 1). On 2D and 3D echocardiography, the umbilical catheter was seen passing through the foramen ovale (Fig. 2, Videos 1 and 2). Left-to-right atrial shunt was then sufficient to discharge the left atrium (Fig. 2A, Video 1). As soon as the catheter was removed, the foramen ovale became restrictive, with a concomitant decrease in saturation to 55% (Fig. 3A). A Rashkind procedure was performed, which improved blood flow between the two atria (Fig. 3B) and increased capillary saturation to 85%. The fossa ovalis membrane, which had restricted the blood flow (Fig. 3C, Video 3), was torn up by the procedure (Fig. 3D, Video 4). Transposition of the great arteries is a well-known cause of isolated neonatal cyanosis. When the atrial septal defect is restrictive before surgery (consisting of an arterial switch a few days after the birth), a percutaneous atrioseptostomy (Rashkind procedure) is required. Sometimes, this invasive procedure has to be performed promptly in order to avoid premature death. Our observation shows that, in patients admitted to hospitals located far from centre specialized in this procedure, an umbilical venous catheter pushed into the left atrium (further than normally) may keep open the foramen ovale until the Rashkind procedure can be performed. To our knowledge, this is the first report of this rescue technique.