Effect of balloon atrial septostomy on cerebral oxygenation in neonates with transposition of the great arteries

Abstract

Background:The aim of this study was to determine the effect of balloon atrial septostomy (Bas) on cerebral oxygenation in neonates with transposition of the great arteries (TGa). Methods: In term neonates with TGa, regional cerebral tissue oxygen saturation (r c sO 2 ) was measured using near-infrared spectroscopy (NIRs) for a period of 2 h, before Bas, after Bas, and 24 h after Bas. In neonates who did not require Bas on clinical grounds, r c sO 2 was measured within 24 h of admission and 24 h later. results: Bas was performed in 12 of 21 neonates. r c sO 2 increased from a median of 42% (before) to 48% at 2 h after Bas (P < 0.05), as did transcutaneous arterial oxygen saturation (spO 2 ) (from 72% to 85%, P < 0.01). r c sO 2 increased further during the next 24 h (from 48% to 64%, P < 0.05), whereas spO 2 remained stable. although beginning from a lower baseline (42 vs. 51%, P < 0.01), r c sO 2 was higher in neonates treated with Bas, as compared with neonates not treated with Bas, 24 h after the procedure (64 vs. 58%, P < 0.05); spO 2 was, however, similar between the two groups. conclusion: Bas improves cerebral oxygen saturation in neonates with TGa. complete recovery of cerebral oxygen saturation occurred only 24 h after Bas.

No difference found in safety or efficacy of balloon atrial septostomy performed at the bedside versus the catheterisation laboratory

“…3 Balloon atrial septostomy can be performed in the cardiac catheterisation laboratory using fluoroscopy, with or without ultrasound assistance, or at the patient's bedside using echocardiographic guidance alone. [4][5][6][7] The decision regarding where to perform the septostomy is often based on physician or institutional preference, with safety concerns or desire to visualise coronary artery anatomy often cited when the catheterisation laboratory is preferred. Prior studies have supported the safety and efficacy of both procedure locations.…”

Decreased tissue oxygenation in newborns with congenital heart defects: a case-control study

“…Although the exact limit of the appropriate brain oxygenation as assessed by NIRS is debatable and has not been accurately established ( 6 , 7 , 10 , 23 , 25 ), the significantly lower brain rSO 2 in the CHD group points to impaired oxygen supply.…”

“…Some other methodological limitations of our study should also be considered. The main problem remains the high spatial, temporal, and inter-subject variability of NIRS ( 3 , 6 , 7 , 10 , 12 , 23 , 27 ). Although the use of single point optode remains a concern, the strong correlation of rSO 2 values between the right and the left hemisphere emphasizes the accuracy of our data.…”

“…Although the use of single point optode remains a concern, the strong correlation of rSO 2 values between the right and the left hemisphere emphasizes the accuracy of our data. It has also been suggested that the intervention outcome in a specific patient should be assessed, rather than absolute rSO 2 values ( 5 , 10 , 12 , 23 , 28 ). However, our data confirm the value of absolute values assessment.…”

Monitoring the Neonate: Basic Science

“…After balloon septostomy for transposition of the great arteries, NIRS showed signifi cant improvement in ScO 2 compared with the group that did not undergo septostomy by 24 h [ 65 ]. In critically ill neonates before and after surgery, NIRS is applied on the head and fl ank or abdomen to determine ScO 2 , SkO 2 (kidney), SlO 2 (liver), or SgO 2 (gut) to guide ICU treatments or timing of surgery.…”