Scoring system to determine need for balloon atrial septostomy for restrictive interatrial communication in infants with hypoplastic left heart syndrome

Abstract

Background Restrictive interatrial communication (IAC) causes morbidity and mortality in infants with hypoplastic left heart syndrome awaiting cardiac transplantation. We sought to create a scoring system, based on echocardiographic and clinical findings, to serve as a guide for determining the need for balloon atrial septostomy (BAS). Methods We retrospectively reviewed echocardiograms of 44 infants with hypoplastic left heart syndrome. Infants were studied from the time of admission to the final end-point of transplantation, Norwood procedure, or death. Seventeen infants underwent BAS for clinical indications of oxygen saturation <80% in room air. Data collected included age at BAS, maximum velocity (V max), and IAC diameter throughout the clinical course. We assigned higher IAC scores to smaller IAC diameter, greater V max through the IAC, and lower oxygen saturation value. The minimum score was 3, and the maximum score was 9. Results Only 10% of infants with a score <6 at presentation required BAS, whereas 67% of those with scores ≥6 required BAS. Higher IAC scores at presentation were associated with earlier need for BAS ( p = 0.04). Conclusions The IAC scoring system can serve as a reliable clinical guide for identifying infants with hypoplastic left heart syndrome who are likely to require BAS for relief of critically restrictive IAC while awaiting cardiac transplantation.