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Transseptal approach in children after patch occlusion of atrial septal defect: first experience with the cutting
M B Schneider1, P A Zartner, A G Magee
1Department of Pediatric Cardiology, Humboldt University, Berlin, Germany.
Insights
Transseptal access was needed for stent redilation in two children with atrial septal defects previously closed with pericardial patches. Cutting balloons successfully created interatrial communications when patches thickened, enabling further treatment.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Pediatric Cardiology
Background:
- Atrial septal defects (ASDs) are commonly closed surgically, sometimes with pericardial patches.
- Late complications can necessitate re-intervention, posing unique challenges.
Observation:
- Two pediatric patients developed thickened interatrial patches after prior ASD closure.
- These patches obstructed transseptal access required for endovascular stent redilation.
Findings:
- A transseptal approach to the left heart was successfully performed in both patients.
- Cutting balloons were utilized to perforate the thickened interatrial patches, establishing adequate interatrial communications.
- This allowed for successful stent redilation, addressing the restenosis or obstruction.
Implications:
- Cutting balloons are a viable tool for managing thickened interatrial tissue during transseptal procedures.
- This technique expands interventional options for complex pediatric cardiac cases.
- It highlights the potential for late complications after pericardial patch closure of ASDs.
Abstract:
Two children required a transseptal approach to the left heart for endovascular stent redilation late after pericardial patch closure of atrial septal defects performed at the time of their initial surgical intervention. Following perforation of thickened interatrial patches in both patients, cutting balloons were used to create adequate interatrial communications. Cathet. Cardiovasc. Intervent. 48:378-381, 1999.