The natural history of transposition after balloon septostomy and before surgical repair
Prior to the introduction of balloon atrial septostomy  the mortality of infants with transposition was high, even with state-of-the-art palliation . Undoubtedly, Rashkind’s innovation resulted in a revolutionary change in outlook for such infants. What is more, it came at a time when this improvement could be exploited to maximum effect due to the introduction and widespread success of the Mustard procedure for atrial redirection of venous return [10,1]. Early in the experience of the use of balloon atrial septostomy the results seemed so self-evidently good  that little attention was paid to factors which might determine survival and thus might be influenced to improve outcome. Haemodynamic improvement was talked of in terms of percentage increase in arterial oxygen saturation and was not further analysed until some 6 years had passed. By this time, it had become evident that anatomical factors influenced the effect on arterial oxygenation and physiological influences were being sought. By the early 1970s we understood that the most dramatic increases in arterial saturation were seen in those with the poorest natural anatomical sites for intracirculatory mixing. In fact, the effect on the population of infants was to convert the two populations of ‘poor mixers’ and ‘good mixers’ into one population of better mixers . Despite the improvements in haemodynamics and early survival there was a continuous attrition, and survival at 30 months was of the order of 50% .
KeywordsVentricular Septal Defect Great Artery Arterial Oxygen Saturation Balloon Atrial Septostomy Mustard Procedure
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