Mattia Donald, Coronado Claire, Garn Byron, Graziano Joseph N, McLaughlin Ericka Scheller, Lindblade Christopher
Phoenix Children's Center for Heart Care, Phoenix, USA.
University of Arizona College of Medicine, Phoenix, USA.
Pediatr Cardiol. 2024 Oct 9. doi: 10.1007/s00246-024-03679-3.
Infants with dextro-transposition of the great arteries (d-TGA) are at high risk for hemodynamic compromise in the immediate postnatal period due to dependence on intracardiac mixing for oxygen delivery. This period of profound hypoxemia may have long-term implications, as previous studies demonstrated patients with d-TGA are at increased risk for neurocognitive delays despite effective surgical correction in the neonatal period. Balloon atrial septostomy (BAS) is an established intervention that improves intracardiac mixing and perioperative hemodynamics. This retrospective study aimed to quantify the time from birth to BAS and compare short-term outcomes for patients with prenatal and postnatal diagnoses of d-TGA. We identified 68 newborns born with d-TGA who were admitted to our facility between 2013 and 2022 and required BAS within 48 h after birth. Halfway through this study, our cardiac interventional team began traveling to a nearby delivery center where a bedside BAS could be performed prior to transferring the patient. We divided the patients into 3 groups-postnatal diagnosis (n = 27), prenatal diagnosis with rapid transport (n = 24), and prenatal diagnosis with interventional team performing a BAS at the delivery hospital (n = 17). The time from birth to BAS was significantly shorter for patients in the interventional program group (1.1 h) compared to the rapid transport (4.5 h) and postnatal diagnosis groups (9.3 h, p value < 0.01). The interventional program group also had lower lactate levels and less acidotic pH compared to the other groups. There was no significant difference in lowest oxygen saturation level, pre-surgical neurologic complication rate, time to surgery, or hospital length of stay. The interventional program proved to be a safe and effective model, as there were no procedural complications and the time to BAS decreased. Long-term follow-up is needed to determine if abating this initial period of hemodynamic instability will lead to improved neurodevelopmental outcomes.
患有大动脉右位转位（d-TGA）的婴儿在出生后即刻因依赖心内混合来输送氧气而面临血流动力学受损的高风险。这段严重低氧血症时期可能具有长期影响，因为先前的研究表明，尽管在新生儿期进行了有效的手术矫正，但d-TGA患者出现神经认知延迟的风险增加。球囊房间隔造口术（BAS）是一种既定的干预措施，可改善心内混合和围手术期血流动力学。这项回顾性研究旨在量化从出生到BAS的时间，并比较产前和产后诊断为d-TGA的患者的短期结局。我们确定了68例出生时患有d-TGA的新生儿，他们在2013年至2022年期间入住我们的机构，并在出生后48小时内需要进行BAS。在这项研究进行到一半时，我们的心脏介入团队开始前往附近的分娩中心，在那里可以在转运患者之前进行床边BAS。我们将患者分为3组——产后诊断组（n = 27）、快速转运的产前诊断组（n = 24）和介入团队在分娩医院进行BAS的产前诊断组（n = 17）。与快速转运组（4.5小时）和产后诊断组（9.3小时，p值<0.01）相比，介入项目组患者从出生到BAS的时间明显更短（1.1小时）。与其他组相比，介入项目组的乳酸水平也更低，酸中毒pH值也更低。最低氧饱和度水平、术前神经系统并发症发生率、手术时间或住院时间没有显著差异。介入项目被证明是一种安全有效的模式，因为没有手术并发症，且到BAS的时间缩短了。需要进行长期随访以确定减轻这一初始血流动力学不稳定期是否会导致改善神经发育结局。
