Balloon atrial septostomy under echocardiographic control: six years' experience and evaluation of the practicability of cannulation via the umbilical vein

Balloon atrial septostomy was undertaken under cross sectional echocardiographic control in 63 consecutive infants: in no case was fluoroscopic imaging required. The procedure was performed in the cardiac catheterisation laboratory, ward side room, or at the bedside in the neonatal intensive care unit. Catheterisation via the umbilical vein was attempted in 37 infants aged less than 48 hours old and was successful in 27. No complication was clearly attributable to the procedure though two infants died. A nine day old child died from disseminated intravascular coagulation the day after septostomy by the iliofemoral route and another, aged nine days, died of necrotising enterocolitis which had developed when he was eight days old, after umbilical catheterisation at eight hours. Balloon atrial septostomy is a safe and easy procedure under cross sectional echocardiographic imaging control. Catheterisation via the umbilical vein was safe, easy to perform, and is appropriate in infants aged less than 48 hours.     

Balloon atrial septostomy under echocardiographic control: six years'' experience and evaluation of the practicability of cannulation via the umbilical vein.

Balloon atrial septostomy was undertaken under cross sectional echocardiographic control in 63 consecutive infants: in no case was fluoroscopic imaging required. The procedure was performed in the cardiac catheterisation laboratory, ward side room, or at the bedside in the neonatal intensive care unit. Catheterisation via the umbilical vein was attempted in 37 infants aged less than 48 hours old and was successful in 27. No complication was clearly attributable to the procedure though two infants died. A nine day old child died from disseminated intravascular coagulation the day after septostomy by the iliofemoral route and another, aged nine days, died of necrotising enterocolitis which had developed when he was eight days old, after umbilical catheterisation at eight hours. Balloon atrial septostomy is a safe and easy procedure under cross sectional echocardiographic imaging control. Catheterisation via the umbilical vein was safe, easy to perform, and is appropriate in infants aged less than 48 hours.     

Balloon atrial septostomy using echocardiographic monitoring

Six patients with d-transposition of the great arteries and 1 patient with tricuspid atresia were diagnosed echocardiographically. Balloon atrial septostomy (BAS) was performed successfully in all cases with the aid of two-dimensional echocardiography. Echocardiography may be superior to fluoroscopy during BAS because it permits easy detection of spontaneous passage of the inflated catheter into the left ventricle spontaneously through the mitral valve (like a left atrial myxoma). With the visualization of related cardiac structures during BAS, obstruction of the IVC with the balloon was also prevented. Using this method, bedside application of BAS is possible.     

Balloon atrial septostomy with echocardiographic guidance

At the Childrens Hospital National Medical Center, Washington, DC, two-dimensional echocardiography has been used to guide balloon atrial septostomy in 17 neonates with cyanotic congenital heart disease and has proved helpful in minimizing the risks associated with this procedure.     

Balloon atrial septostomy under two-dimensional echocardiographic control

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.     

Balloon atrial septostomy in the neonatal intensive care unit.

In eight infants with complete transposition of the great arteries balloon atrial septostomy was performed in the neonatal intensive care unit solely under cross sectional echocardiographic control. One infant developed necrotising enterocolitis; otherwise there were no complications. This technique eliminates the need for radiographic screening during the procedure, is quick, and causes little disturbance to the infant who does not have to be removed from the incubator.     

Balloon and blade atrial septostomy facilitated by two-dimensional echocardiography

Two-dimensional echocardiography (2-D echo) was used as an imaging device for the performance of balloon atrial septostomy (n = 25) and blade atrial septostomy (n = 3). Biplane fluoroscopy with 2-D echo or 2-D echo alone were used in the cardiac catheterization laboratory to place the balloon or blade septostomy catheter in the left atrium. Echocardiography confirmed the position of the septostomy catheter before pullback. Balloon inflation and balloon or blade pullback to the right atrium was performed with 2-D echocardiographic visualization. In 8 critically ill newborn infants, balloon atrial septostomy was done in the neonatal intensive care unit without flouroscopy. The safety and efficacy of 2-D echo to assist balloon or blade atrial septostomy in the catheterization laboratory or as the sole imaging device in the neonatal intensive care unit are confirmed. Use of the subcostal 4-chamber and sagittal views to image cardiac anatomy and catheter position during the procedure are emphasized. Two-dimensional echo is particularly helpful in cases of cardiac malposition and during transseptal puncture of the atrial septum before blade septostomy, and lowers radiation dose when used in conjunction with fluoroscopy.     

Balloon atrial septostomy under two dimensional echocardiographic control.

Two dimensional echocardiography has been used to guide balloon atrial septostomy in five cases of transposition of the great arteries. A single lumen balloon catheter was used. The catheter can be accurately located within the left atrium before inflation of the balloon, thus avoiding some of the traumatic accidents possible during septostomy. The balloon can be observed creating the atrial defect and the approximate size of the resulting defect noted. It can also be seen if the foramen ovale is only being stretched and not torn. The use of the two dimensional echocardiogram during septostomy should significantly contribute to the speed, efficiency, and safety of the procedure.     

Balloon atrial septostomy: The oldest cardiac interventional procedure in Mansoura

BackgroundBalloon atrial septostomy (BAS) was first described by Rashkind and Miller in 1966 and remains an important interventional procedure in the palliation of certain forms of congenital heart disease (CHD). Creating an atrial septa1 defect in patients with transposition of the great arteries (d-TGA) will enhance bidirectional mixing of the pulmonary and systemic venous blood, hence improving oxygen saturation. The aim of the work is to review and report our experience using balloon atrial septostomy in different CHD.MethodWe retrospectively reviewed the hospital records, echocardiographic and cardiac catheterization reports of patients subjected for BAS during the period from January 2001 till January 2010. One hundred and ninety two patients with CHD (78.5% d-TGA, 10% mitral atresia, 7.5% tricuspid atresia, and 4% hypoplastic left heart syndrome) underwent BAS. Their gestational age was 38.63 ± 1.48 weeks, postnatal age (median 3.5 days, range 1–54) and weight 3.08 ± 0.37 kg, 57.5% was male and 42.5% was female. All patients received PGE1 infusion before the procedure to maintain the ductal patency in a dose of 0.05–0.1 μg/kg/min.ResultsOne hundred twenty two procedures (63.5%) were done in neonatal intensive care at bedside and 70 procedures (36.5%) in the catheterization laboratory. General anesthesia was used in 31.3% of patients whereas conscious sedation was used in 68.7% of patients. Femoral access in 78% while umbilical access in 22%. Seven F sheath was used in 100% of case. The Miller catheter was used in 75% and a Z-5 septostomy catheter in 25% of cases. The diameter of the atrial communication increased from 2.75 ± 0.97 mm to 7.07 ± 0.79 mm (p < 0.0001). Oxygen saturations increased significantly from 65.38 ± 9.59% to 88.62 ± 3.13% (p < 0.0001). Mean pressure gradient for patients done in catheterization laboratory decreased from 4.1 ± 2.4 to 0.5 ± 1.1 mmHg (p < 0.0001). The number of septostomies required to achieve good results was 5.23 ± 1.20. No significant difference in oxygen saturation or the size of inter-atrial communication was observed between the two used balloons (p = 0.6).ConclusionBAS is safe and an effective palliative procedure for different CHD with good immediate results in our institution.     

Balloon dilation atrial septostomy for advanced pulmonary hypertension in patients on prostanoid therapy

Methods : All patients had progressive symptoms despite prostanoid therapy at the time of their first BDAS. Sixteen patients who underwent a total of 23 septostomies between 2004 and 2014 were included in this retrospective case series. Conclusions : BDAS may be an alternate therapy for select PH patients who have symptomatic progression despite prostanoid therapy. Survival is comparable to prior reports of BDAS in the pre‐prostanoid era. © 2014 Wiley Periodicals, Inc.