Arterial switch in the first hours of life: no need for Rashkind septostomy?

Abstract

ASO for D-TGA in the first hours of life is a good option for the treatment of critically ill neonates with metabolic disorders. In our experience, there is no need for the Rashkind procedure to stabilize the patient before surgery.

Transposition of the Great Arteries—Outcomes and Time Interval of Early Neonatal Repair

“…12,13 Nevvazhay et al reported eight patients with favorable outcomes after ASO in the first 24 hours of life as an alternative to septostomy but did not provide results of a comparison group. 12 Chasovskyi et al demonstrated the feasibility of using umbilical cord blood in 21 patients undergoing ASO at a mean age of 11 hours. 13 Compared to 40 control patients with a mean age at ASO of 7.7 days, the early repair group had a lower total LOS.…”

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“…[2][3][4][5][6][7] In these diseases signs of PFO restriction should alert the clinician and require urgent Rashkind procedure or anticipation of surgical correction/palliation. [2][3][4][5][6][7] Foramen ovale is easily evaluated by echocardiography.…”

“…[2][3][4][5][6][7] In these diseases signs of PFO restriction should alert the clinician and require urgent Rashkind procedure or anticipation of surgical correction/palliation. [2][3][4][5][6][7] Foramen ovale is easily evaluated by echocardiography. [1][2][3][4][5][6][7] Echocardiography is also commonly employed to guide the Rashkind procedure as well as to evaluate its result.…”

“…[2][3][4][5][6][7] Foramen ovale is easily evaluated by echocardiography. [1][2][3][4][5][6][7] Echocardiography is also commonly employed to guide the Rashkind procedure as well as to evaluate its result. 8 9 Despite this no clear echocardiographic criteria exist at present to define a foramen ovale 7 neither to judge if it is restrictive or less.…”

“…[2][3][4][5][6][7] No clear cut-off values exist to define the presence and severity of restriction of a PFO, however a mean Doppler gradient of 5 mm Hg has been indicated by some [2][3][4][5][6][7] while others used more strict criteria (velocity >120 cm/s). 7 In conclusion, at present no clear echocardiographic criteria exist to define a restrictive PFO.…”