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Al-Kassmy J, Navarro-Castellanos I, Barlatay FG, Miró J, Dahdah N. Balloon Atrial Septostomy: Does the Balloon Size Matter? CJC PEDIATRIC AND CONGENITAL HEART DISEASE 2022; 1:253-259. [PMID: 37969484 PMCID: PMC10642134 DOI: 10.1016/j.cjcpc.2022.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 10/18/2022] [Indexed: 11/17/2023]
Abstract
Background Dextro-transposition of the great arteries is a congenital heart defect with eventually lethal life-threatening consequences of hypoxic low cardiac output. When a balloon atrial septostomy (BAS) is needed, it is performed shortly after birth to create an interatrial shunt and improve systemic blood oxygenation and haemodynamic conditions. In 2019 and 2020, the withdrawal of some balloon atrioseptostomy catheters from the market led to increased use of catheters with different materials, shapes, and sizes. The main objective of this study was to investigate whether the size of the Miller and Fogarty balloon (Edwards Lifesciences) in its 2 variations, the 4.0 cc and the 1.8 cc, had a different impact on the systemic oxygen saturation, on the atrial septal defect (ASD) size, or on the type and frequency of procedure-related complications. Methods We conducted a retrospective study on 134 consecutive patients diagnosed with dextrotransposition of the great arteries between 2002 and 2018 who underwent BAS in a tertiary paediatric hospital in Canada. Results BAS resulted in a significant increase in oxygen saturation of 18.91% ± 12.95% points (P < 0.0001) and a significant increase in the resulting ASD by 3.92 ± 1.58 mm (P < 0.0001). There was no significant difference in resulting oxygen saturation (P = 0.8370) or the final ASD size (P = 0.2193) based on the balloon size. Severe or life-threatening complications were rare (1%) with no subsequent patient demise. Conclusions This is the first study to show that the small balloon is as efficient as the large balloon catheter including in premature patients. This raises the question whether different balloon sizes are necessary.
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Affiliation(s)
- Jawad Al-Kassmy
- Royal College of Surgeons in Ireland, School of Medicine, Dublin, Ireland
- Department of Paediatrics, Division of Paediatric Cardiology, Sainte-Justine University Hospital Center, Montréal, Québec, Canada
| | - Iñaki Navarro-Castellanos
- Department of Paediatrics, Division of Paediatric Cardiology, Sainte-Justine University Hospital Center, Montréal, Québec, Canada
| | - Francisco Gonzalez Barlatay
- Department of Paediatrics, Division of Paediatric Cardiology, Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - Joaquim Miró
- Department of Paediatrics, Division of Paediatric Cardiology, Sainte-Justine University Hospital Center, Montréal, Québec, Canada
| | - Nagib Dahdah
- Department of Paediatrics, Division of Paediatric Cardiology, Sainte-Justine University Hospital Center, Montréal, Québec, Canada
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Mishra J. Atrial Septostomy and Atrial Septal Stenting: Role of Echocardiography. JOURNAL OF THE INDIAN ACADEMY OF ECHOCARDIOGRAPHY & CARDIOVASCULAR IMAGING 2022. [DOI: 10.4103/jiae.jiae_9_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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3
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Kumar N, Shaikh AS, Kumari V, Patel N. Echocardiography guided bed side balloon atrial septostomy in dextro transposed great arteries (dTGA) with intact ventricular septum (IVS): A resource limited country experience. Pak J Med Sci 2018; 34:1347-1352. [PMID: 30559783 PMCID: PMC6290203 DOI: 10.12669/pjms.346.15792] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Objective: To determine effectiveness and safety of echocardiography guided bed side Balloon Atrial Septostomy (BAS) in dextro transposition of great Arteries (dTGA) with intact ventricular septum (IVS) at a public sector tertiary care hospital Karachi, Pakistan. Methods: This case series include 40 patients with echocardiographic findings of dTGA with IVS and restricted PFO (≤ 2mm) who underwent bedside BAS at department of pediatric cardiology NICVD, Karachi, Pakistan. We recorded pre and post BAS diameter of PFO/Atrial Septal Defect (ASD), oxygen saturation (SpO2 %), and post procedure complications and outcome. Results: Median age was 16 days, Majority of them (n=23, 58%) were severely cyanosed with SpO2 of 41.4±3.4% and underwent emergency BAS and remaining underwent elective procedure. An increase in SpO2% from 46.0±6% to 81.0±3.0% (p=<0.001) and ASD size from 1.4±2.8mm to 5.45±0.4mm was observed (p=<0.001). No complication was observed in most of cases (n=28, 70%). Mean hospital stay was 3.4±1 days. Success rate was 97.5% however, one neonate died due to neonatal sepsis. Conclusion: Our study provides sufficient evidence that bed side balloon atrial septostomy is a safer technique, save a lot of time and resources which were required otherwise in transporting these patients to catheterization laboratory.
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Affiliation(s)
- Naresh Kumar
- Naresh Kumar, FCPS, Fellow Paediatric Cardiology, NICVD Karachi, Pakistan
| | - Abdul Sattar Shaikh
- Abdul Sattar Shaikh, FCPS, Assistant Professor of Paediatric Cardiology, NICVD Karachi, Pakistan
| | - Veena Kumari
- Veena Kumari, FCPS, Fellow Paediatric Cardiology, NICVD Karachi, Pakistan
| | - Najma Patel
- Najma Patel, FCPS, FSCAI, Professor and Head of the Department, Paediatric Cardiology, NICVD Karachi, Pakistan
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4
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No difference found in safety or efficacy of balloon atrial septostomy performed at the bedside versus the catheterisation laboratory. Cardiol Young 2018; 28:1421-1425. [PMID: 30152306 DOI: 10.1017/s1047951118001439] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Balloon atrial septostomy is performed in infants with dextro-transposition of the great arteries to improve oxygenation before surgery. It is performed in the catheterisation laboratory with fluoroscopy or at the bedside using echocardiography. It is unclear whether procedural safety and efficacy is superior in one location versus the other, although the bedside procedure may improve resource utilisation and present an opportunity for reducing cost. This study compares safety and efficacy of atrial septostomy performed at the patient's bedside versus the catheterisation laboratory. METHODS Neonates with dextro-transposition of the great arteries who underwent balloon atrial septostomy from October, 2000 to January, 2014 were included. Medical and procedural records, echocardiograms, and catheterisation data were reviewed. Comparisons between the two procedural locations included patient demographics, pre- and post-procedure oxygen saturations, and outcomes. Complications reviewed included bleeding, arrhythmia, cardiac trauma, stroke, and death. Coronary artery evaluations were recorded. T-tests were used for continuous variables, and Fisher's exact tests were used for all categorical variables. Wilcoxon rank sum and analysis of covariance modelling were used for time variables and oxygen saturation, respectively. RESULTS A total of 88 infants met the inclusion criteria. Among them, 53 underwent septostomy at the bedside and 35 underwent septostomy in the catheterisation laboratory. No safety or outcome benefit was identified between the two procedural locations. CONCLUSION Septostomy performed at the bedside and in the catheterisation laboratory had similar outcomes and efficacy. Further, bedside septostomy has the advantage of no radiation exposure, and obviating risks with patient transfer from the ICU to the catheterisation laboratory.
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5
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Matter M, Almarsafawy H, Hafez M, Attia G, Elkhier MMA. Balloon atrial septostomy: The oldest cardiac interventional procedure in Mansoura. Egypt Heart J 2011. [DOI: 10.1016/j.ehj.2011.08.043] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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6
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Boehm W, Emmel M, Sreeram N. Balloon atrial septostomy: history and technique. IMAGES IN PAEDIATRIC CARDIOLOGY 2006; 8:8-14. [PMID: 22368660 PMCID: PMC3232558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- W Boehm
- University Hospital of Cologne, Germany
| | - M Emmel
- University Hospital of Cologne, Germany
| | - N Sreeram
- University Hospital of Cologne, Germany.,Contact information: N. Sreeram, Department of Paediatric Cardiology, University Hospital of Cologne, Kerpenerstrasse 62, 50937 Cologne, Germany Phone: +49 221 47886301 Fax: +49 221 47886302
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7
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Mazić U, Berden P, Podnar T. Repetitive paroxysms of supraventricular tachyarrhythmias triggered during pediatric cardiac interventions: suppression after short infusion of amiodarone. Pediatr Cardiol 2004; 25:684-5. [PMID: 14743306 DOI: 10.1007/s00246-003-0644-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Arrhythmias are the most common major complications encountered during pediatric cardiac catheterizations. This report describes the management of repetitive paroxysms of supraventricular tachyarrhythmias triggered by catheter manipulation during interventional procedures in two children. After 15 minutes, amiodarone infusion (25 microg/kg/min) eliminated further paroxysms in both patients, allowing both interventions to be completed safely and effectively.
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Affiliation(s)
- U Mazić
- University Children's Hospital, University Medical Center Ljubljana, Vrazov trg 1, 1525, Ljubljana, Slovenia
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8
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See PL, David E, Anderson-Weller K, Fong LV, Menahem S. Maternal infant bonding enhanced after atrial septostomy in cyanotic neonates in a general hospital. Early Hum Dev 2003; 71:9-17. [PMID: 12614946 DOI: 10.1016/s0378-3782(02)00071-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
UNLABELLED Seventeen newborns in a general hospital had a successful atrial septostomy when indicated. Mostly done at the bedside under echocardiographical guidance, the successful introduction of this procedure enabled the infants to remain with mother to facilitate feeding and bonding prior to elective transfer to a children's hospital for corrective surgery. BACKGROUND Atrial septostomy is a well-recognised intervention in the newborn to facilitate atrial mixing in transposition of the great arteries (TGA) or to decompress an atrium where the connecting AV valve is absent or stenosed, e.g. tricuspid atresia (TA). AIMS To review the outcome of this procedure in a general hospital with appropriate neonatal and cardiological facilities. METHODS Retrospective review over an 11-year period. RESULTS Seventeen inborn infants had successful atrial septostomies, 11 with TGA and 6 with TA. All done under general anaesthesia, 15 were performed in the newborn nurseries, under echocardiographic guidance, and 2 in the catheter laboratory. No complications occurred. Eleven had a prenatal diagnosis made. All infants were able to be subsequently nursed by their mothers, affording prime time facilitating feeding and bonding. They were electively transferred to a children's hospital for corrective surgery. CONCLUSIONS Atrial septostomy can be safely performed in a general hospital with appropriate neonatal and cardiological expertise. Such intervention allows for elective transfer of the infant for corrective surgery, allowing the infant and mother to be initially cared for at the one hospital, thereby facilitating maternal contact, feeding and bonding, doing away with the added stress of emergency transfer.
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Affiliation(s)
- Pei Lee See
- Paediatric Cardiology Unit, Monash University, Melbourne, Victoria, Australia
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9
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Zellers TM, Dixon K, Moake L, Wright J, Ramaciotti C. Bedside balloon atrial septostomy is safe, efficacious, and cost-effective compared with septostomy performed in the cardiac catheterization laboratory. Am J Cardiol 2002; 89:613-5. [PMID: 11867054 DOI: 10.1016/s0002-9149(01)02309-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Thomas M Zellers
- The Division of Pediatric Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center at Dallas, 75235, USA.
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Qureshi SA, Redington AN, Wren C, Ostman-Smith I, Patel R, Gibbs JL, de Giovanni J. Recommendations of the British Paediatric Cardiac Association for therapeutic cardiac catheterisation in congenital cardiac disease. Cardiol Young 2000; 10:649-67. [PMID: 11117403 DOI: 10.1017/s1047951100008982] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The aims of these recommendations are to improve the outcome for patients after, and to provide acceptable standards of practice of therapeutic cardiac catheterisation performed to treat congenital cardiac disease. The scope of the recommendations includes all interventional procedures, recognising that for some congenital malformations, surgical treatment is equally as effective as, or occasionally preferable to, interventional treatment. The limitations of the recommendations are that, at present, no data are available which compare the results of interventional treatment with surgery, and certainly none which evaluate the numbers and types of procedures that need to be performed for the maintenance of skills. Thus, there is a recognised need to collect comprehensive data with which these recommendations could be reviewed in the future, and re-written as evidence-based guidelines. Such a review will have to take into account the methods of collection of data, their effectiveness, and the latest developments in technology. The present recommendations should, therefore, be considered as consensus statements, and as describing accepted practice, which could be used as a basis for ensuring and improving the quality of future care.
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Alcíbar Villa J, García Fernández E, Gutiérrez-Larraya Aguado F, Moreno Granado F, Pan Alvarez-Osorio M, Santos de Soto J. [Guidelines of clinical practice of the Spanish Society of Cardiology. Requirements and equipment of invasive techniques in pediatric cardiology: clinical application]. Rev Esp Cardiol 1999; 52:688-707. [PMID: 10523881 DOI: 10.1016/s0300-8932(99)74990-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Invasive techniques in pediatric cardiology have experienced a big change since the 80's. The growth of non-invasive methods for diagnosing congenital heart defects has made the number of diagnostic catheterizations decrease remarkably. On the other hand, the notable development of pediatric interventional catheterization techniques will allow that, in the near future, the number of therapeutic catheterizations overcomes the diagnostic ones in our country. The former are more difficult and dangerous, so they require experienced and skilled hands and more economic resources. This chapter is divided in three main sections: I) Requirements and equipment needed for pediatric invasive techniques; II) Current indications, contraindications and complications of the diagnostic catheterization, and III) Techniques, indications and results of pediatric therapeutic catheterization: current state. Likewise, we state the suitability or not for these therapeutic procedures in different cardiac anomalies.
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PATEL HITENDRAT, CAO QILING, HIJAZI ZIYADM. Balloon Atrial Septostomy: The Oldest Pediatric Interventional Procedure. J Interv Cardiol 1998. [DOI: 10.1111/j.1540-8183.1998.tb00132.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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13
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Allen HD, Beekman RH, Garson A, Hijazi ZM, Mullins C, O'Laughlin MP, Taubert KA. Pediatric therapeutic cardiac catheterization: a statement for healthcare professionals from the Council on Cardiovascular Disease in the Young, American Heart Association. Circulation 1998; 97:609-25. [PMID: 9494035 DOI: 10.1161/01.cir.97.6.609] [Citation(s) in RCA: 76] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Abstract
Balloon atrial septostomy is recommended as a standard palliative procedure in neonates with congenital heart defects who are dependent on intracardiac shunting. We describe an unusual and unreported complication associated with "bedside" balloon atrial septostomy. The umbilical venous catheterization resulted in displacement of a thrombus from the ductus venosus or the hepatic vein. We recommend careful two-dimensional echocardiographic monitoring during such procedures.
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Affiliation(s)
- J S Chandar
- Department of Pediatrics, University of Miami School of Medicine, Florida 33101
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15
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Ward CJ, Hawker RE, Cooper SG, Brieger D, Nunn G, Cartmill TB, Celermajer JM, Sholler GF. Minimally invasive management of transposition of the great arteries in the newborn period. Am J Cardiol 1992; 69:1321-3. [PMID: 1585867 DOI: 10.1016/0002-9149(92)91229-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
This study reports on a predominantly noninvasive management program for neonatal transposition of the great arteries [TGA] incorporating balloon atrial septostomy [BAS] under echocardiographic control. BAS was performed in 25 consecutive patients presenting with TGA between April 1988 and April 1990. Structural and coronary anatomy was evaluated echocardiographically with angiographic supplementation only when additional data were required. This information was correlated, where possible, with direct anatomic findings and subsequent course. BAS was performed through the umbilicus in 17 patients (85% of patients in whom this approach was attempted). Thirteen patients did not require ventilation during BAS. There were minimal complications and satisfactory septostomies in all cases. Coronary anatomy was correctly predicted in all patients where anatomic correlation was available. Without invasive investigation 9 patients underwent neonatal arterial switch procedures and 2 underwent palliative procedures. BAS under echocardiographic control proved safe, effective, minimally traumatic and mostly possible via the umbilical vein. The umbilical vein, where patent, permitted rapid safe access for BAS. Echocardiographic diagnosis of the coronary artery, and structural and functional anatomy was reliable and allowed minimally invasive preoperative management in many patients.
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Affiliation(s)
- C J Ward
- Adolph Basser Institute of Cardiology, Royal Alexandra Hospital for Children, Camperdown, Sydney, Australia
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Abstract
We report our experience with balloon atrial septostomy under two-dimensional echocardiographic guidance only in 44 newborn patients (39 patients with transposition of the great arteries) who needed creation of an interatrial communication. Using standard echocardiographic projections septostomy with creation of large atrial septal defects was easy in 41 newborns. In 3 patients insertion of a large Eustachian valve at the interatrial septum prevented adequate pull-throughs with larger balloon sizes. No serious complications due to the procedure were noted. Balloon atrial septostomy under two-dimensional echocardiographic control is a quick, effective and safe method which can be performed on the intensive care unit.
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Affiliation(s)
- A Beitzke
- Department of Pediatric Cardiology, Children's Hospital University of Graz, Austria
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17
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D'Orsogna L, Lam J, Sandor GG, Patterson MW. Assessment of bedside umbilical vein balloon septostomy using two-dimensional echocardiographic guidance in transposition of great arteries. Int J Cardiol 1989; 25:271-7. [PMID: 2613374 DOI: 10.1016/0167-5273(89)90217-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The effectiveness of "bedside" balloon atrial septostomy via the umbilical vein using 2-dimensional echocardiography was compared to the traditional femoral vein approach using fluoroscopy in a series of neonates with transposition of great arteries from March, 1984 to April, 1987. There were 7 neonates who had balloon septostomy performed at the "bedside" (Group I) compared to 13 who had the procedure performed in the catheterization laboratory (Group II). Group II consisted of 7 newborns who had elective femoral vein catheterization under fluoroscopy (Group IIA) and 6 who failed "bedside" umbilical vein balloon septostomy and subsequently had the femoral vein approach under fluoroscopy (Group IIB). Results showed that adequacy of balloon septostomy was not related to the approach used, with 4 of 7 in Group I and 9 of 13 in Group II with an adequate atrial tear and clinical response. The Delay time to septostomy (i.e. time elapsed from initial assessment to commencement of balloon septostomy) and Procedure time (i.e. time taken to complete the balloon septostomy) was significantly shorter for Group I (mean time = 0.7 hours and 0.26 hours respectively) compared with Group IIA (mean time = 2.6 hours and 1.8 hours) and Group IIB (mean time = 2.4 hours and 1.4 hours). Of note, there was no significant increase in Delay time between Group IIA and IIB.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- L D'Orsogna
- Department of Paediatrics, University of British Columbia, B.C. Children's Hospital Vancouver, Canada
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MARANTZ PABLO, CAPELLI HORACIO, LUDOMIRSKY ACHI, FAELLA HORACIO, PERRIELLO MARTA, MICHELLI DIEGO, CORONEL ALBERTORODRIGUEZ, BERRI GUSTAVO. Echocardiographic Assessment of Balloon Atrial Septostomy in Patients with Transposition of the Great Arteries: Prediction of the Need for Early Surgery. Echocardiography 1988. [DOI: 10.1111/j.1540-8175.1988.tb00240.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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19
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Lau KC, Mok CK, Lo RN, Leung MP, Leung CY. Balloon atrial septostomy under two-dimensional echocardiographic control. Pediatr Cardiol 1987; 8:35-7. [PMID: 3601735 DOI: 10.1007/bf02308382] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Balloon atrial septostomy was performed under two-dimensional echocardiographic control in 18 consecutive neonates. Initially, a subcostal long-axis view was used to guide the catheter into the right atrium. Then, by tilting the transducer medially, a plane traversing the inferior vena caval-right atrial junction, foramen ovale, and left atrium was obtained to direct the manipulation of the catheter into the left atrium and monitor the septostomy procedure. As the catheter was always in view, catheter manipulation was easy and complications were avoided.
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