Balloon atrial septostomy: The oldest cardiac interventional procedure in Mansoura

Abstract

Background: Balloon 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. Method: We 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. Results: One 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). Conclusion: BAS is safe and an effective palliative procedure for different CHD with good immediate results in our institution.

Keywords

• Balloon atrial septostomy
• Transposition of great arteries
• Atrial septal defect