Balloon atrial septostomy under echocardiographic control: six years' experience and evaluation of the practicability of cannulation via the umbilical vein

Balloon atrial septostomy is a technique in which a catheter containing a balloon is inserted into the heart and used to make an opening in the septum, between the right and the left atria (the upper, receiving chambers). It is used in infants to treat a number of birth defects of the heart that cause cyanosis (low oxygenation of the blood, resulting in a bluish color). When the catheter is inserted, it must be done carefully to avoid damaging heart structures. Fluoroscopy, an X-ray technique for visualizing internal organs using a scope, has been used in the past to help guide the catheter. However, it cannot directly visualize structures inside the heart. Echocardiography, an imaging technique for visualizing the heart that uses high frequency sound waves, can clearly visualize intracardiac anatomy. It may thus be more useful than fluoroscopy in performing septostomy. It has also been shown that the catheter can be inserted into the heart more quickly and easily via the umbilical vein. This route limits manipulation of the catheter, but is generally adequate. This study examined the results at a facility performing balloon atrial septostomy via the umbilical vein and using echocardiography for guidance. The procedure was performed on 63 infants between September 1984, and September 1990. Echocardiography provided adequate visualization in all the patients and the atrial septal 'defect' was successfully created in all the patients. Catheterization via the umbilical vein was only attempted in 37 infants who were less than two days old. It was successful in all but 10 of these infants. These 10 were catheterized by other routes and no complications from the umbilical attempt were seen. These results show that echocardiography makes balloon atrial septostomy safer and easier to perform and that catheterization via the umbilical vein should first be tried in infants less than two days old. (Consumer Summary produced by Reliance Medical Information, Inc.)