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CASE REPORT

Stubborn Hypoxia in Neonates with D-Transposition of the Great Arteries after Arterial Switch Operation: Central Sleep Apnea as the Cause and Potential Indicator of Brain Immaturity

Camden L. Hebson1,*, Kyle Bliton2, Amr Y. Hammouda1, Kaitlyn Barr3, W. Hampton Gray4, Mohini Gunnett2, Waldemar F. Carlo1
1 Department of Pediatrics, Division of Pediatric Cardiology, University of Alabama Birmingham, Birmingham, 35233, USA
2 Department of Pediatrics, Division of Pediatric Pulmonology, University of Alabama Birmingham, Birmingham, 35233, USA
3 Department of Pediatrics, University of Alabama Birmingham, Birmingham, 35233, USA
4 Department of Surgery, Division of Cardiothoracic Surgery, University of Alabama Birmingham, Birmingham, 35233, USA
* Corresponding Author: Camden L. Hebson. Email: email

Congenital Heart Disease https://doi.org/10.32604/chd.2024.048871

Received 20 December 2023; Accepted 21 February 2024; Published online 25 March 2024

Abstract

D-transposition of the great arteries (d-TGA) is surgically repaired with the arterial switch operation (ASO) with excellent results, however short and long-term morbidities still develop including neurocognitive delay. Clinically significant central sleep apnea is uncommon in non-premature infants, but when present indicates immature autonomic control of respiration likely due to a neurologic disorder. We report the unanticipated finding of central sleep apnea in four-term neonates with d-TGA after uncomplicated ASO, with the short-term complication of delayed hospital discharge and long-term concerns regarding this early marker of brain immaturity and its hindrance to normal development. Within this report, we will review each patient’s clinical course and then examine the literature on pediatric central sleep apnea, neurodevelopmental outcomes after ASO, and the important overlap of these entities in the care of patients going forward.

Keywords

Transposition; congenital heart disease; sleep apnea; polysomnography

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