ROLE OF PROSTAGLANDIN-E1 INFUSION IN THE MANAGEMENT OF TRANSPOSITION OF THE GREAT-ARTERIES

That prostaglandin E1 can produce an increase in systemic oxygen saturation in patients with cyanotic heart disease and ductus dependent pulmonary blood flow has been well documented. However, its use in complete transposition to increase systemic oxygen saturation by increasing mixing has not been well investigated. Ten newborn infants with angiographic diagnosis of d-transposition of the great arteries and patent ductus arteriosus were studied; 6 had an intact ventricular septum. Prostaglandin E1 infusion (0.1 μg/kg per min) was started after balloon atrial septostomy because of a persistently low systemic oxygen saturation of 26 ± 12 percent (mean ± standard deviation) and oxygen tension of 17 ± 5 torr. The infusion resulted in an increase in systemic oxygen saturation to 53 ± 19 percent (P < 0.01) and oxygen tension to 30 ± 9 torr (P < 0.001). In 2 of 10 patients, there was no increase in systemic oxygen saturation with the infusion (1 had the infusion before the septostomy and both had the infusion for less than 10 minutes). In 8 of 10 patients, the infusion was continued from 4 to 312 hours (average 98 hours) until a Blalock-Hanlon procedure was performed. Two babies became septic, and one of them died. A third had a transient fever. All children whose prostaglandin E1 infusion was discontinued before atrial septectomy had a reduction in systemic oxygen saturation to unacceptable levels. Two patients who required infusion (for 5 days) after septectomy were successfully weaned from the drug. It is concluded that dilation of the ductus by prostaglandin E1 infusion increases pulmonary blood flow (left to right shunt) which in turn favorably influences atrial mixing (left to right shunt) and increases systemic oxygen saturation. Pulmonary blood flow may be further increased by a decrease in pulmonary vascular resistance induced by prostaglandin E1. © 1979.