| Blade atrial septostomy in infants with cyanotic congenital heart diseases. |
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In Sook Park, Young Hwue Kim, Chang Yee Hong |
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Department of Pediatrics, Asan Medical Center, Ulsan University Medical School, Seoul, Korea |
| 선천성 심질환 영아에서의 칼날을 이용한 섬방중격 절개술* |
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박인숙, 김영휘, 홍창의 |
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울산대학교 의과대학 아산재단 서울중앙병원 소아과학교실 |
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Received: 3 June 1991 • Accepted: 6 August 1991 |
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| Abstract |
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In patients with certain types of congenital heart malformations, an adequate interatrial communi-
cation is essential for survival and balloon atrial septostomy (BAS) is a life saving procedure in these
infants.
However, BAS alone is not successful in older infants and children with thickened atrial septum,
and blade septostomy is indicated in these situations. This procedure so far has not been reported in
Korean literature and in this communication, we describe our recent experience of this procedure in
5 infants with cyanotic congenital heart disease.
Five infants underwent blade atrial septostomy at Asan Medical Center during the period from
August 1989 to March 1991. Age ranged from 1.3 to 9 months and body weight ranged from 3.7 to
8.5 kg. There were 4 males and one female. Cardiac diagnosis were tricuspid atresia with pulmonary
stenosis in one, severe pulmonary valve stenosis or atresia with intact ventricular septum in two,
single ventricle, double inlet and double outlet right ventricle with pulmonary stenosis in one, and
complete transposition of the great arteries with pulmonary stenosis, ventricular septal defect and
tricuspid stenosis in a criss-cross heart in one patient. All these patients had restrictive atrial
communications.
Blade septostomy was performed using standard technique with 6F blade septostomy catheter with
a 1 cm blade length through a 7F transsptal sheath. This was immediately followed by balloon
septostomy. Efficacy of the procedure was assessed by measuring pressure gradients between the two
atria, measuring arterial oxygen satuations, angiograms in the atrium and echocardiography, as well
as clinical evaluation.
Repeat angiograms of the atria and two-dimensional and color Doppler echocardiography demon-
strated enlarged atrial septal defects in all patients. Three patients experienced transient complica-
tions during the diagnostic cardiac catheterizations and these were not directly related to the blade
septostomy procedure.
(CONCLUSION) (1) Blade atrial septostomy was successful in enlarging atrial septal communica-
tions in all 5 patients without major complication. (2) Pressure gradient or arterial oxygen saturation
did not help to evaluate the efficacy of this procedure. (3) Two-dimensional echocardiography best
demonstrated the anatomy of the enlarged atrial septal defect with clear demonstration of the cut
edge of the septum and its motion with each cardiac cycle. (4) Follow up evaluation in 4 patients
confirmed the continuing beneficial effect of this procedure. (5) Blade septostomy should be perfor-
med when older infants and children require enlargement of the atrial septal communications, instead
of surgical Blalock-Hanlon atrial septectomy, which is shown to carry some long term sequele and
may render total correction at later time more complicated.
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| Key Words:
Blade atrial septostomy, Balloon atrial septostomy, Cyanotic congenital heart disease |
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