Thrombus formation in the heart following balloon atrial septostomy in transposition of great arteries

Talwar, Sachin; Kumar, Gaind; Ramakrishnan, Sivasubramanian; Gharde, Parag; Choudhary, Shiv Kumar

doi:10.1007/s12055-022-01331-4

Indian J Thorac Cardiovasc Surg

2022

DOI: 10.1007/s12055-022-01331-4

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Thrombus formation in the heart following balloon atrial septostomy in transposition of great arteries

Sachin Talwar

Gaind Kumar

Sivasubramanian Ramakrishnan

et al.

Abstract: Thrombotic complications following balloon atrial septostomy (BAS) are unusual. We report a patient with thrombus formation at the site of BAS, extending into the inferior vena cava (IVC), following BAS for transposition of great arteries with intact ventricular septum (TGA-IVS). An urgent arterial switch operation (ASO) with removal of the thrombus was performed. Supplementary Information The online version contains supplementary material available at 10.1007/s12055-022-01331-4.

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2024

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Revisiting the Role of Balloon Atrial Septostomy Prior to the Arterial Switch Operation

Subramanian,

Jani,

Well

et al. 2024

World J Pediatr Congenit Heart Surg

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Objectives Patients with dextro-transposition of the great arteries (d-TGA) frequently undergo balloon atrial septostomy (BAS) prior to the arterial switch operation (ASO) to promote atrial-level mixing. Balloon atrial septostomy has inherent risks as an invasive procedure and may not always be necessary. This study revisits the routine utilization of BAS prior to ASO. Methods Single-center, retrospective review of d-TGA patients undergoing the ASO from July 2018 to March 2023. Preoperative patient characteristics, pulse oximetry oxygen saturations (SpO2), cerebral/renal near-infrared spectroscopy (NIRS) readings along with prostaglandin status at the time of the ASO were analyzed with descriptive and univariate statistics. Results Thirty patients underwent the ASO. Of these, 7 (23%) were female, 25 (83%) were white, and median weight at ASO was 3.2 kg (range 0.8-4.2). Twenty-two (73%) patients underwent BAS. There were no demographic differences between BAS and no-BAS patients. Of those who underwent BAS, there was a significant increase in SpO2 (median 83% [range 54-92] to median 87% [range 72-95], P = .007); however, there was no change in NIRS from pre-to-post BAS. Six (27%) patients in the BAS group were prostaglandin-free at ASO. Balloon atrial septostomy patients underwent the ASO later compared with no-BAS patients (median 8 [range 3-32] vs 4 [range 2-10] days old, P = .016) and had a longer hospital length of stay (median 13 [range 7-43] vs 10 [range 8-131] days, P = .108). Conclusions While BAS is an accepted preoperative procedure in d-TGA patients to improve oxygen saturations, it is also an additional invasive procedure, does not guarantee prostaglandin-free status at the time of ASO, and may increase the interval to ASO. Birth to direct early ASO, with prostaglandin support, should be revisited as an alternative, potentially more expeditious strategy.

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Revisiting the Role of Balloon Atrial Septostomy Prior to the Arterial Switch Operation

Subramanian,

Jani,

Well

et al. 2024

World J Pediatr Congenit Heart Surg

View full text Add to dashboard Cite

show abstract

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Thrombus formation in the heart following balloon atrial septostomy in transposition of great arteries

Cited by 1 publication

References 4 publications

Revisiting the Role of Balloon Atrial Septostomy Prior to the Arterial Switch Operation

Revisiting the Role of Balloon Atrial Septostomy Prior to the Arterial Switch Operation

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