Bailon Atrial Septostomy Under Echocardiographic Guidance: Availa bility in emergency conditions

Balloon atrial septostomy (BAS) is a standard palliative procedure in neonates with d-transposition of the great arteries (TGA) and it has traditionally been performed in the cardiac cathetcrization laboratory. The cross-sectional echocardiography (echo) has been used to help during the procedure. During a period of 9 months, 12 patients, ll of thcm with TGA, admitted to our Clinics, underwent BAS under echo guidance. Their ages ranged 1- 55 days, and they weighed 2500-4400 gr. The intervention was realized in neonatal intensive care unit (ICU). Under local anesthesia and sedation with midazolam, 4 Fr. arterial sheath was inserted to femoral vein, thereafter was exchanged with 7 Fr. arterial sheath. BAS was realized with standard technic using 5 F Miller BAS catheter. While the diaınete r of interatrial co mınun icat i on ranged I -3 .2 mm. before septostomy, it reached 6.5 mm. on average and Oı saturation increased from 47% to 78 % in patients with TGA. The sheath was in the feınoral artery instead of vein in two patients, but no arterial coınplication was observed in both of tlıese cases. We observed nodal rhythın in one paticnt, and a supraventricular tachycardia in another. Both of them reverted spontaneously. The baby with TGA may need ınanagemen t in the ICU. Transferring the baby who is mechanically ventilated to the catheteri sation laboratory takes time and can be harınful for him. Moreover, it carries risk of ex tubation and heat loss. BAS und er echocardiographic guidance is an c ffcctivc alternative to the classical fluoroscopic proccdurc and is less time consuming under special circuınstances.