[Atrial septostomy with a balloon catheter under echocardiographic control. Our experience]

We report our experience in balloon atrial septostomy using two-dimensional echocardiography as control for the catheter placement and performance of the procedure instead of traditional fluoroscopic control.

We carried out atrial septostomy in 12 consecutive neonates with age between 1 and 18 days (mean = 3.6 +/- 5 days) diagnosed as d-transposition of the great arteries (10 cases) and pulmonary atresia with intact ventricular septum (2 cases). The procedures were performed in the catheterization laboratory in 7 cases. In the five remaining cases it was done in the neonatal intensive care unit. We emphasise the good visualization of the full balloon within the left atrium and its relationship with the mitral valve and the pulmonary veins, as well as, the problems found in case number 2 for initial placement of the catheter in the left atrium.

An adequate atrial septal defect was achieved in all patients with diameter between 6 and 12 mm (mean = 8.6 +/- 2 mm). There were no complications using this technique, except a supraventricular tachycardia which stopped spontaneously. The evolution of the patients have been satisfactory, and 11 of them underwent surgery. Patient number 2 died suddenly on the third day after atrial septostomy.

We conclude that atrial septostomy with balloon catheter can be carried out safely, under echocardiographic control in the intensive care unit. Above all, critical patients should not be removed from the unit because they are high risk patients.