Related Experiment Video
Updated: Sep 20, 2026
Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
Scoring system to determine need for balloon atrial septostomy for restrictive interatrial communication in infants
Neda F Mulla1, Anne P Osher, W Lawrence Beeson
1Department of Pediatrics, Division of Pediatric Cardiology, Loma Linda University Children's Hospital, Loma Linda, California 92534 , USA. nmulla@ahs.llumc.edu
Insights
A new scoring system for interatrial communication (IAC) in infants with hypoplastic left heart syndrome helps predict the need for balloon atrial septostomy (BAS). Higher scores indicate a greater likelihood of requiring BAS.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease
- Echocardiography
Background:
- Restrictive interatrial communication (IAC) significantly impacts infants with hypoplastic left heart syndrome (HLHS) awaiting cardiac transplantation.
- Timely intervention is crucial to mitigate morbidity and mortality associated with restrictive IAC.
Purpose of the Study:
- To develop and validate a scoring system using echocardiographic and clinical data.
- To guide the determination of the need for balloon atrial septostomy (BAS) in infants with HLHS.
Main Methods:
- Retrospective review of echocardiograms from 44 infants with HLHS.
- Data collection included age at BAS, maximum velocity (V(max)) through IAC, IAC diameter, and oxygen saturation.
- A scoring system was created, assigning higher scores to smaller IAC diameter, greater V(max), and lower oxygen saturation.
Main Results:
- Infants with a score <6 at presentation had a 10% likelihood of requiring BAS.
- Infants with scores ≥6 had a 67% likelihood of requiring BAS.
- Higher IAC scores correlated with an earlier need for BAS (p = 0.04).
Conclusions:
- The developed IAC scoring system reliably identifies infants with HLHS likely to need BAS.
- This tool aids in managing critically restrictive IAC in infants awaiting cardiac transplantation.
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 > or =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.
