Impact of balloon atrial septostomy in neonates with transposition of great arteries

Objective: To examine the impact of balloon atrial septostomy (BAS) on cardio-respiratory status, need for prostaglandin E ₁ (PGE ₁) and postoperative outcomes in infants with transposition of great arteries (TGA). Study Design: Single-center retrospective review of consecutive neonates with dTGA. Result: BAS was performed in 42 (70%) infants and resulted in a significant increase in minimum (61 to 76%) and maximum (80 to 90%) oxygen (O ₂) saturations and a drop in FiO ₂. BAS was 'successful,' that is, PGE ₁ was discontinued in 16 (38%) infants. Three infants died; four infants developed strokes, all of whom had undergone BAS. The duration of hospitalization, ventilation and O ₂ need did not differ between infants without BAS, 'successful' BAS and unsuccessful BAS. PGE ₁ duration correlated with duration of hospitalization, ventilation, O ₂ need and peak respiratory severity score (P<0.03). Conclusion: We speculate that limiting BAS for clinical hypoxemia and aggressive weaning of PGE ₁ following BAS would improve outcomes.