Balloon atrial septostomy under two-dimensional echocardiographic control: a new outlook.

Abstract

Between January 1989 and February 1995 a group of 47 consecutive infants aged 31-180 days (mean 83.5 +/- 48.8 days) with various cyanotic heart diseases and poor intracardiac mixing underwent balloon atrial septostomy (BAS) under two-dimensional (2D) echocardiographic control in the procedure room or intensive care unit. Diagnoses were 27 cases of transposition of the great arteries (TGA), 1 mitral atresia, 9 tricuspid atresia, 7 critical pulmonary stenosis with hypoplastic right ventricle, 3 pulmonary atresia with intact interventricular septum, and 1 total anomalous pulmonary venous return. A standard subcostal view was used mainly to delineate the interatrial septum and to guide the balloon catheter. The creating (tearing) of the atrial septal defect was seen clearly during the procedure, and the 2D echocardiographic imaging was helpful for assessing the adequacy of the BAS at the end of the procedure. The results were good (5-9 mm in diameter) with no significant complications. The 2D echocardiographic scans showed no significant changes in the created atrial hole sizes during the follow-up of 1-6 months. We conclude that BAS under 2D echocardiographic control can be performed successfully and safely in infants with cyanotic congenital heart disease up to 6 months of age. This method should be considered for palliation, avoidance of surgery, or allowing the patient to survive until an appropriate time for corrective surgery.