Transcatheter PDA recanalization and interatrial septal stenting as a bridge to arterial switch operation in a late-presenting infant with D-transposition of the great arteries.

BACKGROUND

Dextro-transposition of the great arteries with intact ventricular septum (d-TGA/IVS) requires early arterial switch operation (ASO) to preserve left ventricular function, but delayed presentations complicate outcomes due to LV regression and hypoxemia. Alternative bridging strategies are essential for late-presenting patients to improve surgical feasibility.

CASE REPORT

We present a six-month-old male patient with dextrocardia, situs inversus, d-TGA/IVS who experienced persistent cyanosis despite prior balloon atrial septostomy (BAS). On admission, the patient exhibited severe hypoxemia (SpO₂ 33%), metabolic acidosis, and LV regression (LV mass index: 36-41 g/m2). Echocardiography confirmed a restrictive atrial septal defect (3.5 mm) and the absence of a patent ductus arteriosus (PDA). Given the prohibitive risk of immediate ASO, an emergency transcatheter intervention was performed. PDA recanalization was attempted. Following successful wire passage, balloon angioplasty and stent deployment restored systemic-to-pulmonary shunting, improving oxygen saturation to 56%. To further augment intercirculatory mixing, a 10.0 mm × 29 mm Omnilink Elite stent was implanted across the interatrial septum, increasing oxygen saturation to 85%. The patient demonstrated stable post-procedural hemodynamics and was subsequently bridged to elective ASO, which was performed successfully after two months.

CONCLUSION

Transcatheter PDA recanalization and interatrial septal stenting represent a viable bridge to ASO in late-presenting d-TGA/IVS patients. This minimally invasive approach expands treatment options in resource-limited settings where early surgical intervention is not always feasible.