Prenatal Detection of D-TGA and Novel Interventional Program Decrease Time to Balloon Septostomy.
Donald Mattia1, Claire Coronado2, Byron Garn2,3
1Phoenix Children's Center for Heart Care, Phoenix, USA. Djmattia14@gmail.com.
Pediatric Cardiology
|October 9, 2024
Summary
Balloon atrial septostomy (BAS) significantly reduces the time to treatment for infants with dextro-transposition of the great arteries (d-TGA). This intervention improves early hemodynamic stability, though long-term neurodevelopmental benefits require further study.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease
- Interventional Cardiology
Background:
- Infants with dextro-transposition of the great arteries (d-TGA) face immediate risks of hemodynamic compromise and hypoxemia.
- Early hypoxemia in d-TGA may contribute to neurocognitive delays, even after surgical correction.
- Balloon atrial septostomy (BAS) is crucial for improving intracardiac mixing and stabilizing hemodynamics in d-TGA patients.
Purpose of the Study:
- To evaluate the impact of an interventional program on the time from birth to BAS in neonates with d-TGA.
- To compare short-term clinical outcomes between infants diagnosed prenatally versus postnatally.
- To assess the safety and efficacy of a bedside BAS approach at a delivery center.
Main Methods:
- Retrospective analysis of 68 newborns with d-TGA requiring BAS within 48 hours of birth (2013-2022).
- Patients categorized into three groups: postnatal diagnosis, prenatal diagnosis with rapid transport, and prenatal diagnosis with bedside BAS.
- Comparison of time from birth to BAS, lactate levels, pH, oxygen saturation, neurological complications, time to surgery, and hospital length of stay.
Main Results:
- The interventional program group (bedside BAS) achieved significantly shorter times from birth to BAS (1.1 hours) compared to rapid transport (4.5 hours) and postnatal diagnosis (9.3 hours) groups (p < 0.01).
- Patients in the interventional program group exhibited lower lactate levels and less acidosis (higher pH).
- No significant differences were observed in lowest oxygen saturation, pre-surgical neurological complications, time to surgery, or hospital length of stay.
Conclusions:
- Implementing an interventional program for bedside BAS at a delivery center significantly reduces the time to intervention for d-TGA infants.
- This approach is safe and effective, leading to improved early hemodynamic markers without increasing procedural complications.
- Further long-term follow-up is necessary to determine if early hemodynamic stabilization translates to improved neurodevelopmental outcomes.
