Use of prostaglandin E2 in management of transposition of great arteries before balloon atrial septostomy

Abstract

Fifteen infants with transposition of the great arteries and severe hypoxaemia were treated with prostaglandin E2 infusions before atrial septostomy was performed. Twelve patients had simple transposition and three had small ventricular septal defects. The infusion resulted in a highly significant increase of PaO2 from 22 +/- 3 mmHg to 37 +/- 5 mmHg within one to two hours. Only one patient did not respond to treatment. PaO2 remained constantly above 30 mmHg throughout prostaglandin infusion. After balloon atrial septostomy prostaglandin administration was stopped. Only two patients required reinfusion within 24 hours after septostomy because of a decrease of PaO2 below 25 mmHg. At angiocardiography before balloon septostomy the ductus was of aortic size in eight, and of about half the aortic diameter in six patients. In one infant the ductus was closed. One infant had to undergo early ductus ligation because of heart failure. In 10 of 11 infants who have undergone total correction the initially large ductus had closed spontaneously.