Transesophageal echocardiographic guidance of balloon atrial septostomy

Two newborn infants with transposition of the great vessels and an intact ventricular septum were cyanotic when they underwent bedside balloon atrial septostomy in the neonatal intensive care unit. The procedure was conducted under direct transesophageal two-dimensional echocardiographic guidance. Success of the procedure was evaluated with color flow Doppler and the two-dimensional assessment of the septostomy. This procedure has advantages over catheterization and its attendant fluoroscopy, which usually are performed in the catheterization laboratory, expose the patient to radiation, and necessitate transportation of a patient who is hemodynamically unstable to an often distant catheterization laboratory. Transesophageal echocardiography has several advantages over transthoracic echocardiography in aiding this procedure. It provides an optimal view of the atrial septum, while keeping the chest exposed for observation of respiratory effort and for improved thermoregulation.