Abstract
Two patients born with hypoplastic left heart syndrome and an intact or highly restrictive atrial septum requiring emergent intervention are presented. For both patients, rapid septoplasty was performed using a hybrid approach involving direct atrial puncture and transatrial cutting balloon dilation of the atrial septum. This technique facilitates safe and rapid procedural completion and minimizes the risk of procedural complications in this very-high-risk patient population.
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(A) Transesophageal echo using a 10-Fr intracardiac echo probe demonstrates an intact atrial septum (AVI 3227 kb)
(B) With color-flow mapping, the defect is clearly restrictive (AVI 8694 kb)
(C) A 20-gauge needle and angiocath have been inserted across the atrial septum and sit in the left atrium (AVI 12974 kb)
(D) A floppy-tipped, 0.018-in. wire has been advanced across the atrial septum and is positioned in the left upper pulmonary vein (AVI 10480 kb)
(E) A 7-mm cutting balloon is inflated across the atrial septum (AVI 7669 kb)
(F) Color-flow mapping demonstrates a significantly enlarged and nonrestrictive atrial communication (AVI 14203 kb)
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Hill, K., Fudge, J.C., Barker, P. et al. Novel Transatrial Septoplasty Technique for Neonates with Hypoplastic Left Heart Syndrome and an Intact or Highly Restrictive Atrial Septum. Pediatr Cardiol 31, 545–549 (2010). https://doi.org/10.1007/s00246-009-9627-7
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DOI: https://doi.org/10.1007/s00246-009-9627-7