The First Hours: Stabilizing Your Baby's Heart
At a Glance
In the first hours after a D-TGA diagnosis, doctors stabilize newborns by creating temporary ways for oxygen-rich blood to mix. They use IV Prostaglandin E1 to keep the ductus arteriosus open and may perform a bedside Balloon Atrial Septostomy to enlarge the hole between the upper heart chambers.
The moments immediately following a D-TGA diagnosis are focused on one goal: stabilization. Because your baby’s heart is pumping blood in two separate, parallel loops, the medical team must quickly create “bridges” that allow oxygen-rich blood to reach the rest of the body [1][2].
It is important to remember that these steps are not the final cure; they are temporary measures to keep your baby safe and stable until the Arterial Switch Operation (ASO) can be performed [3][1].
Prostaglandin E1 (PGE1): Keeping the Door Open
Before birth, every baby has a natural shortcut between their main arteries called the Ductus Arteriosus [4]. This shortcut usually closes shortly after birth. In a baby with D-TGA, however, this “door” is a lifeline because it allows blood from the two separate loops to mix [1].
Prostaglandin E1 (PGE1) is a medication given through an IV to prevent this shortcut from closing [3].
- How it works: It acts as a vasodilator, relaxing the muscles in the ductus so it stays open (or “patent”) [4][5].
- What to expect: While life-saving, PGE1 can have side effects. The most common is apnea (brief pauses in breathing), which may mean your baby needs a breathing tube or extra support while on the medication [6][7]. It can be frightening to see your newborn on a ventilator, but it is a very common, medically anticipated step while they are on this medicine. Other common effects include fever or low blood pressure [6][8].
Balloon Atrial Septostomy (BAS): Creating a Shortcut
Sometimes, the medication alone isn’t enough to get enough oxygen into the blood loop heading to the body. In these cases, doctors perform a Balloon Atrial Septostomy (BAS), also known as the Rashkind procedure [9][10].
- The Procedure: A doctor inserts a thin, flexible tube (catheter) with a tiny balloon at the tip into a vein (often in the belly button or groin). They guide it into the heart and through the small natural opening between the top chambers (the foramen ovale) [11][9].
- The “Pop”: Once the balloon is on the other side, the doctor inflates it and quickly pulls it back, creating or enlarging a hole in the wall (the atrial septum) [11][10]. Note that BAS is specifically used to enlarge this hole between the top chambers, while PGE1 manages the separate ductus arteriosus [3].
- The Result: This new, larger hole (now an Atrial Septal Defect or ASD) allows oxygenated blood to mix freely into the systemic loop, immediately improving the baby’s oxygen levels [12][13].
Bedside Convenience
In many modern cardiac centers, the BAS is performed right at your baby’s bedside in the intensive care unit [14]. Doctors use an echocardiogram (ultrasound) to see the heart in real-time, which avoids the need to move a fragile newborn to a separate operating room or catheterization lab [9][15].
Risks and Monitoring
While BAS is a standard and generally safe procedure for D-TGA, it is still an invasive maneuver [14]. Risks can include injury to the heart’s internal structures, the formation of small blood clots, or rhythm disturbances [16][17]. Your baby will be closely monitored by the cardiac team to ensure the “bridge” is working effectively while they prepare for the definitive surgery [17][18].
Common questions in this guide
What does Prostaglandin E1 do for a baby with D-TGA?
What are the side effects of Prostaglandin E1?
What is a Balloon Atrial Septostomy (BAS)?
Will my baby need to go to an operating room for a BAS?
Questions for Your Doctor
4 questions
- •Is my baby currently receiving Prostaglandin E1, and what dose are they on?
- •Are you seeing any side effects from the medication, like pauses in breathing (apnea) or a fever?
- •Does my baby need a Balloon Atrial Septostomy (BAS) right away, or is the current 'mixing' of blood sufficient for now?
- •If a BAS is needed, will it be performed here at the bedside or in the cardiac catheterization lab?
Questions for You
3 questions
- •How am I feeling about the 'temporary' nature of these procedures? Do I understand that these are steps to keep my baby safe until surgery?
- •Do I have a clear point of contact in the NICU or Cardiac ICU if I have questions during the middle of the night?
- •What are my primary concerns about the invasive nature of a bedside procedure like the BAS?
References
References (18)
- 1
Effects of Prostaglandin E1 and Balloon Atrial Septostomy on Cerebral Blood Flow and Oxygenation in Newborns Diagnosed with Transposition of the Great Arteries.
Cucerea M, Ognean ML, Pinzariu AC, et al.
Biomedicines 2024; (12(9)) doi:10.3390/biomedicines12092018.
PMID: 39335532 - 2
The hemodynamic impact of congenital heart diseases during fetal-to-neonatal transition: an in-silico investigation.
van Willigen BG, Krabben BC, van der Hout-van der Jagt MB, et al.
Pediatric research 2026; doi:10.1038/s41390-025-04565-1.
PMID: 41617779 - 3
Elective Non-Urgent Balloon-Atrial Septostomy in Infants with d-Transposition of the Great Arteries Does Not Eliminate the Need for PGE1 Therapy at the Time of Arterial Switch Operation.
Zaleski KL, McMullen CL, Staffa SJ, et al.
Pediatric cardiology 2021; (42(3)):597-605 doi:10.1007/s00246-020-02520-x.
PMID: 33492430 - 4
Developmental Differences in Platelet Inhibition Response to Prostaglandin E1.
Palma-Barqueros V, Torregrosa JM, Caparrós-Pérez E, et al.
Neonatology 2020; (117(1)):15-23 doi:10.1159/000504173.
PMID: 31786577 - 5
Prostaglandin E1 for maintaining ductal patency in neonates with ductal-dependent cardiac lesions.
Akkinapally S, Hundalani SG, Kulkarni M, et al.
The Cochrane database of systematic reviews 2018; (2()):CD011417 doi:10.1002/14651858.CD011417.pub2.
PMID: 29486048 - 6
Prostaglandin E1 overdose in a term neonate with congenital heart disease.
Gorodetsky RM, Toole BM, Schult RF, Wiegand TJ
Clinical toxicology (Philadelphia, Pa.) 2019; (57(6)):420-421 doi:10.1080/15563650.2018.1533137.
PMID: 30451018 - 7
Low-dose prostaglandin E1 is safe and effective for critical congenital heart disease: is it time to revisit the dosing guidelines?
Vari D, Xiao W, Behere S, et al.
Cardiology in the young 2021; (31(1)):63-70 doi:10.1017/S1047951120003297.
PMID: 33140712 - 8
Effect of prostaglandin-E1 treatment on pyloric wall thickness in newborns with ductal-dependent critical congenital heart diseases.
Tandircioglu UA, Turer OB, Soyer T, et al.
Pediatric surgery international 2023; (39(1)):144 doi:10.1007/s00383-023-05428-8.
PMID: 36856877 - 9
Impact of Bedside Balloon Atrial Septostomy in Neonates with Transposition of the Great Arteries in a Neonatal Intensive Care Unit in Romania.
Cirstoveanu C, Georgescu C, Bizubac M, et al.
Life (Basel, Switzerland) 2023; (13(4)) doi:10.3390/life13040997.
PMID: 37109527 - 10
Wire Atrial Septostomy: A New Technique to Create a Large Defect in a Thickened Atrial Septum.
Kitano M, Tsukada M, Fujino M
World journal for pediatric & congenital heart surgery 2020; (11(4)):NP18-NP21 doi:10.1177/2150135116686929.
PMID: 28415904 - 11
Atrial septostomy in the management of pulmonary arterial hypertension: past, present, and future.
Dong M, Song M, Liu J
European journal of medical research 2025; (30(1)):552 doi:10.1186/s40001-025-02776-0.
PMID: 40604947 - 12
Effects of preoperative veno-venous extracorporeal membrane oxygenation management and left atrial pressure reduction via balloon atrial septostomy on respiratory system compliance in a neonate with transposition of the great arteries with intact ventricular septum.
Nishida K, Seino Y, Takeuchi M
Respiratory medicine case reports 2025; (54()):102190 doi:10.1016/j.rmcr.2025.102190.
PMID: 40161468 - 13
Hemodynamic simulation of complete transposition of the great arteries for optimal treatment strategies based on its circulatory physiology.
Sato K, Takamizawa K, Ogawa Y, et al.
American journal of physiology. Heart and circulatory physiology 2024; (326(3)):H812-H820 doi:10.1152/ajpheart.00668.2023.
PMID: 38276950 - 14
Different outcomes of balloon atrial septostomy and the association of C677T polymorphism in MTHFR gene on TGA children.
Salih AF, NazdarAmin BM
Cellular and molecular biology (Noisy-le-Grand, France) 2022; (67(4)):24-32.
PMID: 35809305 - 15
Echocardiography guided bed side balloon atrial septostomy in dextro transposed great arteries (dTGA) with intact ventricular septum (IVS): A resource limited country experience.
Kumar N, Shaikh AS, Kumari V, Patel N
Pakistan journal of medical sciences 2018; (34(6)):1347-1352 doi:10.12669/pjms.346.15792.
PMID: 30559783 - 16
Thrombus formation in the heart following balloon atrial septostomy in transposition of great arteries.
Talwar S, Kumar G, Ramakrishnan S, et al.
Indian journal of thoracic and cardiovascular surgery 2022; (38(4)):434-437 doi:10.1007/s12055-022-01331-4.
PMID: 35370371 - 17
The effect of preoperative balloon atrial septostomy and intraoperative parameters on neurodevelopmental scoring in neonates operated for transposition of the great artery.
Kılıç Y, Güven Baysal Ş, Gül Ö, Aldudak B
Turk gogus kalp damar cerrahisi dergisi 2025; (33(2)):185-195 doi:10.5606/tgkdc.dergisi.2025.26431.
PMID: 40575050 - 18
Prenatal Detection of D-TGA and Novel Interventional Program Decrease Time to Balloon Septostomy.
Mattia D, Coronado C, Garn B, et al.
Pediatric cardiology 2025; (46(7)):2054-2059 doi:10.1007/s00246-024-03679-3.
PMID: 39384586
This page provides educational information on the initial stabilization of infants with D-TGA. Always consult your pediatric cardiologist and intensive care team regarding your baby's specific medical needs and treatment plan.
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