Blade atrial septostomy: Experience with the first 50 procedures

Abstract

We have performed 50 blade and balloon atrial septostomies in 46 patients with diagnoses of transposition of the great arteries--32 patients; mitral atresia or stenosis--10 patients; total anomalous pulmonary venous drainage--2 patients; tricuspid atresia--1 patient; and pulmonary valve atresia with hypoplastic right ventricle--1 patient. The patients' age ranged from 1 day to 72 months (median = 8 months) and weights ranged from 2.7 to 14.5 kg. In patients with transposition the systemic saturation increased from an average of 62% to 74.6% (p less than 0.001) and the inter-atrial mean pressure gradient was reduced from 7.74 +/- 5.3 to 1.4 +/- 2.04 mm Hg. Patients with mitral atresia had no significant increase in systemic arterial saturation but a significant decrease in the mean inter-atrial gradient from 19.6 +/- 12.4 to 3.8 +/- 5.3 mm Hg. In three patients the blade septostomy was unsuccessful for technical reasons and the condition of the patient. Complications included one death due to atrial laceration, blood loss requiring transfusion in 5 patients, transient CVA in one patient, and failure of the blade to close in one patient. We have found the palliative use of the blade catheter in conjunction with balloon atrial septostomy to be an effective and safe procedure.

Atrial septostomy in the treatment of severe pulmonary arterial hypertension

“…18 In an attempt to reduce procedural complications, the graded balloon dilatation technique is more often used despite the higher risk of spontaneous closure of the AS. 9 10 18 In our study the graded balloon dilatation technique was associated with a spontaneous closure rate of 15% compared with 17% reported in the literature.…”

A modified technique of stent fenestration of the interatrial septum improves patients with pulmonary hypertension

“…Different techniques for atrial septostomy have been described. First experience has been established with the use of blade balloon atrial septostomy [10][11][12][13]. However, these procedures were associated with a high procedural mortality rate, ranging from 5 to 50% in a single centre experience due to septal laceration and hypoxemia.…”

Pediatric Therapeutic Cardiac Catheterization

“…84 Although the procedure is considered safe, there are potential complications. Perforation of the right atrium and ventricle 22,80,81 has been reported during prolonged manipulation of the blade. Other complications include air embolism and inability to retract the blade into the catheter.…”