The pediatric cardiology fellow was busy on the phone coordinating the arrival of a Transposition of the Great Arteries (TGA) baby. They were inducing because they wanted the birth to happen in a controlled environment with the catheterization team ready to go. Often these babies are born cyanotic due to 2 separate circulations that fail to supply oxygenated blood to the body. If the baby did not have a communication to mix the oxygenated and deoxygenated blood, he would need immediate catheterization and a Balloon Atrial Septosomy (BAS) to make a hole in the atrial septum.
Around 10am, the fellow received a text saying that the baby was coming. We walked to the Transition Nursery (TN) as she forwarded this information to the appropriate people. The Echo attending came to the TN, waited 10 minutes and left. The Interventional cardiologist attending came with the BAS kit but the baby still hadn’t been born. He also left, requesting a 5-minute warning.
Once the mother started pushing, the baby was born in no time and the Neonatology fellow came rushing through the TN door with the baby. The mother and father only had a chance to glance at their baby before he was taken away. The baby was not cyanotic and his saturations were pretty good. However, it was decided that the baby still needed intubation and BAS. While the intubation was going on, the nurses were giving him fluids and alprostadil to keep the ductus open.
Soon after the intubation, Echo and interventional cardiology attendings reappeared for the BAS. The TN was a bit hectic with various personnel running around: the X-ray tech was there with the machine, the echo machine was in the way, a few nurses were making sure everything was set, cardiology attending was observing from the back talking to the neonatology attending, the fellows were present, and I was trying not to get in the way.
The umbilical artery catheter (UAC) was displaced so the balloon cath was placed through the femoral line. As the atrial septum was visualized with the echo, a wire was placed through the septum into the LA. The balloon was enlarged and yanked through the septum to enlarge the communication. This was done 3 times before they were satisfied with the size of the atrial communication. The baby was stable with good saturations and surgery was scheduled for next Wednesday.