Incidence of stroke in patients with d-transposition of the great arteries that undergo balloon atrial septostomy in the University Healthsystem Consortium Clinical Data Base/Resource Manager.

OBJECTIVES

The aim of this study was to investigate the incidence of stoke in pediatric patients undergoing a balloon atrial septostomy (BAS).

BACKGROUND

Newborn infants with d-transposition of the great arteries (dTGA) can be compromised from significant hypoxemia due to inadequate mixing at the atrial level. BAS can be lifesaving by improving the intra-atrial mixing. BAS, although life-saving, is associated with risks including arrhythmias, infection, bleeding, stroke, or death. Recent studies have conflicting conclusions demonstrating the risk of BAS and brain injury using magnetic resonance imaging. However, these studies did not demonstrate the clinical significance of brain injury through physical manifestations of stroke.

METHODS

The University HealthSystem Consortium Clinical Data Base/Resource Manager (UHC CDB/RM) consists of 103 Academic Medical Centers, and affiliated institutions. The CDB/RM was queried using billing codes upon discharge from the consortium hospitals from 2004 to 2008.

RESULTS

In total, the UHC CDB/RM contained information on 1,295 neonatal patients (group 1) who were discharged with a diagnosis of dTGA, of which 440 had a BAS during the same hospitalization. In group 1, 18 had a coded diagnosis of stroke and only six of these 18 had a BAS. In group 2 (pediatric patients with dTGA), 952 patients were discharged with a diagnosis of dTGA, of which 37 had BAS. Pediatric patients (19 of 952) had a stroke and none of them had a BAS.

CONCLUSIONS

In over 2,000 cases of dTGA reported in the CDB/RM over a 4-year period, BAS was not associated with an increased risk of clinical stroke either in the neonatal period or in follow-up hospitalizations.