All issues > Volume 34(12); 1991

Original Article

J Korean Pediatr Soc. 1991;34(12):1655-1663. Published online December 31, 1991.

Blade atrial septostomy in infants with cyanotic congenital heart diseases.

In Sook Park¹, Young Hwue Kim¹, Chang Yee Hong¹

¹Department of Pediatrics, Asan Medical Center, Ulsan University Medical School, Seoul, Korea

Received: June 3, 1991;  Accepted: August 6, 1991.

Abstract

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.

Keywords :Blade atrial septostomy;Balloon atrial septostomy;Cyanotic congenital heart disease