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Archivos de Pediatría del Uruguay

On-line version ISSN 1688-1249


POSE, Guillermo et al. Cirugía cardíaca de rescate en un lactante con transposición simple de grandes arterias. Arch. Pediatr. Urug. [online]. 2007, vol.78, n.3, pp.231-235. ISSN 1688-1249.

Summary Introduction: patients with simple transposition of the great arteries (TGA), (without non restrictive ventricular septal defect) having for surgery after 8 weeks of life are considered a high risk for the arterial switch (AS) operation. We report a 32 days old infant with delayed presentation, requiring a rescue AS operation after a few hours after admission due to increased cyanosis which did not revert with conventional therapy. Case report: a 32 days old infant was admitted with an arterial oxygen saturation of 68% - 70% with no response to the administration of oxygen at 100%. Doppler echocardiography showed transposition of the great arteries with intact ventricular septum, non-restrictive atrial septal defect and nearly closed ductus arteriosus. PGE1 infusion was started without response. Oxygen saturation remained between 55% - 60%. The patient was immediately transferred to the congenital cardiac unit of the American Hospital. An emergency balloon atrial septostomy with echo surveillance was attempted with a transitory increase in oxygen saturation (80%). Hemodynamic compromise and increased cyanosis developed immediately. Based on echocardiography evaluation an emergency AS operation took place. Postoperative course was uneventful and ventilatory support was discontinued 24 hours after surgery. At 6 months of age the patient is in good condition with normal growth and the echocardiogram revealed good ventricular function without residual defects. Conclusion: in patients with transposition of the great arteries with intact ventricular septum, and presented after the first 3 weeks of life, every effort should be made. The ability of the left ventricle must be verified and an AS operation must be done. In the absence of response to PGE1 infusion, the only option to save patients life is the immediate transfer to a specialized center.


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