Balloon atrial septostomy in hypoplastic left heart syndrome with restrictive atrial septum

Abstract

Background: Rashkind balloon atrial septostomy (BAS) can be challenging in infants with hypoplastic left heart syndrome (HLHS) and small atrial septal defect (ASD). Methods: We retrospectively reviewed all infants with HLHS who underwent surgery and BAS between January 2006 and December 2015. The infants were divided into three groups: no BAS; catheter BAS; and open AS. Infants who underwent catheter BAS were divided into two groups based on atrial septal anatomy: standard and complex. Results: Of the 70 patients, 57 (81%) underwent Glenn surgery. Subsequently, a significant difference in survival was observed: 86% (44/51), 91% (10/11), and 25% (2/8) in the no BAS, catheter BAS, and open AS groups, respectively (P = 0.0002). No significant difference was seen between the no BAS and the catheter BAS groups (P = 1.0). In the 56 patients who underwent catheterization after surgery, no intergroup differences in mean pulmonary artery pressure, pulmonary vascular resistance, or pulmonary artery index were found. We classified catheter BAS into standard (n = 5) and complex (n = 5) based on ASD location, and septum thickness. All patients in the standard group underwent complete Rashkind BAS, but in the complex group, only one patient underwent complete Rashkind BAS, with the remaining requiring initial static BAS (P = 0.048). Following septostomy, ASD size, ASD flow, and percutaneous oxygen saturation (SpO 2 ) were not significantly different between the two groups. Conclusions: Catheter BAS is effective in infants with HLHS and a restrictive atrial septum. Infants with standard or complex atrial septum can achieve equivalent outcomes despite more patients often requiring static BAS.

Static balloon atrial septostomy in Japan in shortage of standard balloon septostomy catheter

“…It could be assumed that this size of the balloon would be chosen for static BAS with a single balloon due to the sheath size of 6Fr or less. On the other hand, it has been reported that static BAS with the double-balloon technique could create good atrial communication [4] . In the present survey, the rating was excellent in 2 of 3 patients who underwent static BAS using the double-balloon technique.…”

“…As for the patients with hypoplastic left heart syndrome and its variants, the need for static BAS is because the usefulness of Rashkind BAS after static BAS has been reported [4] and is because the timing of Norwood and Norwood-Glenn palliation has been delayed due to the increase in the hybrid procedure as initial palliation [11] . In the patients with hypoplastic right ventricle, pulmonary atresia with intact ventricular septum or critical pulmonary stenosis, the static BAS, which facilitates size adjustment, may be preferred because it requires that interatrial communication not be opened too wide to promote right ventricular growth [12] .…”

“…Transcatheter balloon atrial septostomy (BAS) was first reported [1] in 1966 as a neonatal treatment for transposition of the great arteries. It has since been widely applied to various diseases requiring interatrial communication until surgical palliation [2][3][4] and is still an essential catheter intervention more than 50 years later [5] .…”

Delivery room and early postnatal management of neonates with congenital heart disease

“…That can perform cardiac catheterization with atrial septoplasty is needed in these infants. 60,61 In some instances, extracorporeal membrane oxygenation (ECMO) may be initiated before intervention. Of note is that if the lungs are abnormal due to long-standing utero injury, including fetal magnetic resonance imaging suggesting pulmonary lymphangiectasia, there is a very high likelihood of mortality.…”

Modern advances regarding interatrial communication in congenital heart defects

“…The decompression of pulmonary venous drainage performed immediately after birth provided improved surgical results, but remained accompanied by relatively elevated mortality and morbidity; [70][71][72][73][74][75][76][77]…”