Successful Balloon Atrioseptostomy and Arterial Switch Operation in a 6-Month-Old Infant with D-Transposition of the Great Arteries

Background: The arterial switch operation (ASO) is the preferred method of repair for patients with d-transposition of the great arteries (d-TGA). Untreated, more than 50% of patients die within the first month and 90% die within the first year of life. We present a case of a 6-month-old patient with uncorrected d-TGA and successful balloon-atrioseptostomy (BAS) and ASO.

Method: A 6-month-old boy from Marocco, accompanied by his father, traveled to Germany for corrective surgery. Upon admission, the child was significantly dystrophic, with a bodyweight of 3.3 kg, and in critical condition, with severe congestive heart failure and progressive respiratory failure with a peripheral oxygen saturation of 48%. Echocardiography revealed a d-TGA, a restrictive atrial septal defect, a 3-mm perimembranous VSD, and no patent ductus arteriosus. Left ventricular pressure was systemic in the absence of pulmonary stenosis. After initial stabilization and BAS, the ASO was successfully performed. The boy was extubated on the third postoperative day, transferred to the peripheral ward on day 6, and discharged on day 14.

Conclusion: Survival of uncorrected d-TGA beyond the neonatal age is rare; however, our patient beat the odds. In the presenting case, an ASO would normally be performed within 2 weeks of life. Reports about late BAS and late one-stage ASO are scarce. Due to systemic LV pressure in the absence of pulmonary stenosis, we decided on a one-stage approach. We could demonstrate that both successful late BAS and one-stage ASO, in this 6-month-old infant, was feasible, even without prolonged hospitalization.

Publication History

Article published online:
28 January 2023