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PubMed This is a summary of 14 peer-reviewed journal articles Updated
Pediatric Cardiology · D-Transposition of the Great Arteries

Stabilizing Your Baby: The First Days with D-TGA

At a Glance

In the first days after a D-TGA diagnosis, the primary goal in the NICU is to ensure oxygen-rich and oxygen-poor blood can mix. This is achieved using an IV medication called Prostaglandin E1 to keep the ductus arteriosus open, or by performing a balloon atrial septostomy.

The moments and days immediately following a D-TGA diagnosis are a whirlwind of activity. Your baby is moved to a Neonatal or Cardiac Intensive Care Unit (NICU/CICU), where a specialized team of doctors and nurses begins the work of stabilizing their circulation. Because the two main arteries are swapped in D-TGA, the goal of these first days is simple: mixing [1].

The medical team needs to create a way for oxygen-rich (red) blood and oxygen-poor (blue) blood to mingle so the body gets the oxygen it needs to stay healthy until surgery.

Step 1: Keeping the Door Open (Prostaglandin E1)

Before birth, all babies have a small blood vessel called the ductus arteriosus that connects the two main arteries. This vessel naturally closes shortly after birth. However, for a baby with D-TGA, this vessel is a lifeline because it allows blood to mix [2].

Doctors will start an intravenous (IV) infusion of a medication called Prostaglandin E1 (also called PGE1 or Alprostadil) [3]. This medication acts as a powerful vasodilator, keeping the ductus arteriosus open (patent) [4].

  • What to watch for: Because PGE1 causes blood vessels to open wide, your baby may look very flushed, red, and feel hot to the touch (like a fever). This is a normal and expected side effect. The most serious side effect of PGE1 is apnea, which are pauses in breathing [5]. The team uses the lowest dose possible to avoid this, but if it happens, they are fully prepared to place a breathing tube and put your baby on a ventilator to breathe for them [6].

Step 2: Creating a Window (Balloon Atrial Septostomy)

If the PGE1 medication isn’t providing enough oxygen mixing, or if the natural hole between the heart’s upper chambers (the foramen ovale) is too small, the team may perform a Balloon Atrial Septostomy (BAS), also known as the Rashkind Procedure [7][8].

This is a bedside or catheterization-lab procedure where a cardiologist:

  1. Threads a thin, flexible tube (catheter) with a tiny deflated balloon on the end through a vein (usually in the belly button or groin) into the heart [1].
  2. Passes the balloon through the small existing hole between the upper chambers (atria).
  3. Inflates the balloon and pulls it back, gently tearing the tissue to create a larger, permanent hole [7].

This “window” allows red and blue blood to mix freely, which immediately improves oxygen levels and stabilizes the baby for the upcoming Arterial Switch Operation [9]. While it is an invasive procedure with risks like rhythm changes, it is a routine, life-saving tool that cardiac teams perform frequently [1][10].

Continuous Monitoring

While your baby waits for surgery, they will be monitored more closely than perhaps any other patient in the hospital. You will see several types of monitors:

  • Pulse Oximetry: Sensors are placed on the right hand and a foot to check oxygen levels [11]. Doctors compare these “upper” and “lower” body numbers to see how well blood is mixing across the ductus arteriosus.
  • Lactate Levels: Blood tests that check for “acid” in the blood, which tells doctors if the tissues are getting enough oxygen [12].
  • NIRS (Near-Infrared Spectroscopy): Small light-up stickers on the forehead or back that measure oxygen levels in the brain and kidneys in real-time [13].

The constant beeping and many wires are the “eyes and ears” of the team, ensuring your baby stays safe and stable [14].

Common questions in this guide

Why does a newborn with D-TGA need Prostaglandin E1 medication?
Prostaglandin E1 is an IV medication used to keep a small blood vessel called the ductus arteriosus open. This allows oxygen-rich and oxygen-poor blood to mix, keeping your baby stable and providing vital oxygen to their organs until surgery.
Why does my baby look flushed and feel hot while receiving PGE1?
Prostaglandin E1 acts as a powerful vasodilator, meaning it opens blood vessels wide. This can make your baby's skin look flushed and feel hot to the touch, resembling a fever, but it is a normal and expected side effect of the medication.
What is a Balloon Atrial Septostomy?
Also known as the Rashkind procedure, this is a minimally invasive technique where a cardiologist uses a tiny balloon to enlarge the natural hole between the heart's upper chambers. It creates a 'window' that allows blood to mix freely when medications aren't providing enough oxygen.
How do doctors know if my baby is getting enough oxygen in the NICU?
The team tracks your baby's stability using pulse oximetry on their hands and feet, blood tests to check lactate levels, and special NIRS stickers on the forehead and back to measure exactly how much oxygen is reaching the brain and kidneys.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.What are our baby's current oxygen saturation and lactate levels, and do they show that the blood is mixing enough?
  2. 2.Is our baby on the lowest effective dose of Prostaglandin E1 to minimize the risk of breathing pauses?
  3. 3.Does the most recent echocardiogram show a 'restrictive' atrial septum that might require a balloon atrial septostomy?
  4. 4.How are the NIRS monitors showing the oxygen levels in our baby's brain and kidneys?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

References

References (14)
  1. 1

    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
  2. 2

    Lipid microsphere-coated PGE1 improves peritoneal transport and reduces inflammation in peritoneal dialysis: A randomized clinical pilot trial.

    Wang J, Tang S, Xie Y, et al.

    Seminars in dialysis 2021; (34(3)):235-244 doi:10.1111/sdi.12954.

    PMID: 33592131
  3. 3

    Prostaglandin E1 Is an Efficient Molecular Tool for Forest Leech Blood Sucking.

    Zheng F, Zhang M, Yang X, et al.

    Frontiers in veterinary science 2020; (7()):615915 doi:10.3389/fvets.2020.615915.

    PMID: 33490139
  4. 4

    Critical Congenital Heart Disease in Neonates: A Review Article.

    Taksande A, Jameel PZ

    Current pediatric reviews 2021; (17(2)):120-126 doi:10.2174/1573396317666210219162515.

    PMID: 33605861
  5. 5

    Effectiveness of Alprostadil for Ductal Patency.

    Gordon CM, Tan JT, Carr RR

    The journal of pediatric pharmacology and therapeutics : JPPT : the official journal of PPAG 2024; (29(1)):37-44 doi:10.5863/1551-6776-29.1.37.

    PMID: 38332962
  6. 6

    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
  7. 7

    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
  8. 8

    Prevalence and Outcomes of Balloon Atrial Septostomy in Neonates With Transposition of Great Arteries.

    Hamzah M, Othman HF, Peluso AM, et al.

    Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies 2020; (21(4)):324-331 doi:10.1097/PCC.0000000000002191.

    PMID: 31688810
  9. 9

    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
  10. 10

    Balloon atrioseptostomy for transposition of the great arteries in Europe: characteristics and outcomes.

    Lucron H, Malekzadeh-Milani SG, de Montclos TP, et al.

    Revista espanola de cardiologia (English ed.) 2025; (78(8)):694-706 doi:10.1016/j.rec.2024.12.011.

    PMID: 39800140
  11. 11

    Relationship between interatrial communication, ductus arteriosus, and pulmonary flow patterns in fetuses with transposition of the great arteries: prediction of neonatal desaturation.

    Vaujois L, Boucoiran I, Preuss C, et al.

    Cardiology in the young 2017; (27(7)):1280-1288 doi:10.1017/S1047951117000087.

    PMID: 28376948
  12. 12

    Correction of d-Transposition of the Great Arteries Sooner Rather Than Later.

    Rollins CK, Newburger JW

    Circulation 2019; (139(24)):2739-2741 doi:10.1161/CIRCULATIONAHA.119.040012.

    PMID: 31180749
  13. 13

    Cerebral oximetry monitoring in the management of severe hypoxaemia associated with transposition of the great arteries with balloon atrial septostomy.

    Pérez Moreno JC, Nájera Losada DC, Sanabria Carretero P, et al.

    Revista espanola de anestesiologia y reanimacion 2018; (65(5)):294-297 doi:10.1016/j.redar.2017.12.008.

    PMID: 29366495
  14. 14

    Arterial switch operation for transposition of the great arteries: A single-centre 32-year experience.

    Vida VL, Zanotto L, Zanotto L, et al.

    Journal of cardiac surgery 2019; (34(11)):1154-1161 doi:10.1111/jocs.14045.

    PMID: 31508848

This page provides educational information about early D-TGA stabilization and NICU care. Always consult your baby's pediatric cardiologist or neonatologist for specific medical updates and treatment decisions.

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