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Blade atrial septostomy: experience with the first 50 procedures
M A Ali Khan1, J T Bricker, C E Mullins
1Division of Paediatric Cardiology, Riyadh Armed Forces Hospital, Kingdom of Saudi Arabia.
Insights
Blade and balloon atrial septostomies effectively improved systemic saturation in transposition of the great arteries patients. This palliative procedure safely reduced inter-atrial pressure gradients in complex congenital heart disease.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Congenital Heart Disease
Background:
- Atrial septostomy is a critical palliative procedure for infants with complex congenital heart disease.
- Blade and balloon atrial septostomy techniques aim to improve inter-atrial communication and systemic oxygenation.
Purpose of the Study:
- To evaluate the efficacy and safety of combined blade and balloon atrial septostomy in neonates and infants.
- To assess the impact of this procedure on systemic saturation and inter-atrial pressure gradients across various congenital heart defects.
Main Methods:
- 50 blade and balloon atrial septostomies were performed in 46 pediatric patients.
- Patient diagnoses included transposition of the great arteries, mitral atresia/stenosis, and other complex heart conditions.
- Hemodynamic and saturation data were analyzed pre- and post-procedure.
Main Results:
- In transposition of the great arteries, systemic saturation increased significantly (62% to 74.6%, p<0.001) and pressure gradients decreased (7.74 to 1.4 mmHg).
- Mitral atresia patients showed no significant saturation increase but a significant pressure gradient reduction (19.6 to 3.8 mmHg).
- Complications included one death, transfusion in 5 patients, and one transient CVA.
Conclusions:
- Combined blade and balloon atrial septostomy is an effective palliative intervention for specific congenital heart diseases.
- The procedure demonstrates safety and efficacy in improving hemodynamic parameters and oxygenation in selected pediatric populations.
- Technical success was achieved in most cases, with manageable complications.
Abstract:
We have performed 50 blade and balloon atrial septostomies in 46 patients with diagnoses of transposition of the great arteries--32 patients; mitral atresia or stenosis--10 patients; total anomalous pulmonary venous drainage--2 patients; tricuspid atresia--1 patient; and pulmonary valve atresia with hypoplastic right ventricle--1 patient. The patients' age ranged from 1 day to 72 months (median = 8 months) and weights ranged from 2.7 to 14.5 kg. In patients with transposition the systemic saturation increased from an average of 62% to 74.6% (p less than 0.001) and the inter-atrial mean pressure gradient was reduced from 7.74 +/- 5.3 to 1.4 +/- 2.04 mm Hg. Patients with mitral atresia had no significant increase in systemic arterial saturation but a significant decrease in the mean inter-atrial gradient from 19.6 +/- 12.4 to 3.8 +/- 5.3 mm Hg. In three patients the blade septostomy was unsuccessful for technical reasons and the condition of the patient. Complications included one death due to atrial laceration, blood loss requiring transfusion in 5 patients, transient CVA in one patient, and failure of the blade to close in one patient. We have found the palliative use of the blade catheter in conjunction with balloon atrial septostomy to be an effective and safe procedure.