Balloon atrial septostomy under two-dimensional echocardiographic control

doi:10.1016/0167-5273(91)90121-5

International Journal of Cardiology

Volume 30, Issue 1, January 1991, Pages 33-42

https://doi.org/10.1016/0167-5273(91)90121-5 Get rights and content

Abstract

We report our experience with balloon atrial septostomy under two-dimensional echocardiographic guidance only in 44 newborn patients (39 patients with transposition of the great arteries) who needed creation of an interatrial communication. Using standard echocardiographic projections septostomy with creation of large atrial septal defects was easy in 41 newborns. In 3 patients insertion of a large Eustachian valve at the interatrial septum prevented adequate pull-throughs with larger balloon sizes. No serious complications due to the procedure were noted. Balloon atrial septostomy under two-dimensional echocardiographic control is a quick, effective and safe method which can be performed on the intensive care unit.

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Cited by (15)

D-Transposition of the Great Arteries
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Maternal infant bonding enhanced after atrial septostomy in cyanotic neonates in a general hospital
2003, Early Human Development
Seventeen newborns in a general hospital had a successful atrial septostomy when indicated. Mostly done at the bedside under echocardiographical guidance, the successful introduction of this procedure enabled the infants to remain with mother to facilitate feeding and bonding prior to elective transfer to a children's hospital for corrective surgery. Background: Atrial septostomy is a well-recognised intervention in the newborn to facilitate atrial mixing in transposition of the great arteries (TGA) or to decompress an atrium where the connecting AV valve is absent or stenosed, e.g. tricuspid atresia (TA). Aims: To review the outcome of this procedure in a general hospital with appropriate neonatal and cardiological facilities. Methods: Retrospective review over an 11-year period. Results: Seventeen inborn infants had successful atrial septostomies, 11 with TGA and 6 with TA. All done under general anaesthesia, 15 were performed in the newborn nurseries, under echocardiographic guidance, and 2 in the catheter laboratory. No complications occurred. Eleven had a prenatal diagnosis made. All infants were able to be subsequently nursed by their mothers, affording prime time facilitating feeding and bonding. They were electively transferred to a children's hospital for corrective surgery. Conclusions: Atrial septostomy can be safely performed in a general hospital with appropriate neonatal and cardiological expertise. Such intervention allows for elective transfer of the infant for corrective surgery, allowing the infant and mother to be initially cared for at the one hospital, thereby facilitating maternal contact, feeding and bonding, doing away with the added stress of emergency transfer.
Interventional cardiac catheterization
1999, Pediatric Clinics of North America
Over the past decade, the focus of the pediatric catheterization laboratory has changed dramatically from its primary diagnostic function to a conduit for therapeutics. Although the first application of such catheter interventions was described more than 44 years ago by Rubio-Alvarez and Limon-Larson,¹⁴⁵ not until 1966, when Rashkind and Miller¹³² described the technique for percutaneous creation of an atrial septal defect in the setting of complete transposition of the great arteries, did such catheter maneuvers decisively affect patient management.82, 134, 135, 136 Today, therapeutic catheterization techniques have replaced conventional surgery for many lesions. New methods, tested through research protocols in specialized centers, combined with continuous critical evaluation of established techniques, continue to ensure improved and sustained results. The primary consideration of practicing pediatric cardiologists should not be whether such techniques are possible to perform, but whether their clinical utility, morbidity, and mortality justify a nonsurgical approach for patients. Unsuccessful outcomes, including complications and nondefinitive outcomes, may in part yield to experience and improvements in technique.
Therapeutic interventions, such as cardiac surgery, have three principal objectives: (1) improvement or preservation of cardiac function, (2) improvement in longevity, and (3) maintenance or improvement in the quality of life (QOL). Catheterization interventions may be corrective, reparative, or palliative. Catheter therapies may also be applied as adjuncts to surgery. Cooperation has developed between pediatric cardiologists and pediatric cardiac surgeons in planning staged repairs of complex congenital heart disease (CHD). This type of cooperation will increase and is already contributing to far better outcomes for many complex congenital heart lesions.
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2012, Cardiology in the Young
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2020, Critical Care of Children with Heart Disease: Basic Medical and Surgical Concepts: Second Edition
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2013, Pakistan Paediatric Journal

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Original studyBalloon atrial septostomy under two-dimensional echocardiographic control

Abstract

Am J Cardiol

J Pediatr

Am J Cardiol

Am J Cardiol

Am J Cardiol

Prospective diagnosis of d-transposition of the great arteries in neonates by subxyphoid, two-dimensional echocardiography

Circulation

Original study
Balloon atrial septostomy under two-dimensional echocardiographic control