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Static balloon atrial septostomy for the purpose of left heart intervention in postoperative adult CHD

Published online by Cambridge University Press:  11 July 2018

Takanari Fujii ,
Hideshi Tomita ,
Yoshihito Hata ,
Takeshi Sasaki ,
Dai Asada ,
Suguru Tarui ,
Yoshinori Miyahara ,
Kozo Ishino  and
Takashi Soga
Takanari Fujii*
Affiliation:
Cardiovascular Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
Hideshi Tomita
Affiliation:
Cardiovascular Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
Yoshihito Hata
Affiliation:
Cardiovascular Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
Takeshi Sasaki
Affiliation:
Cardiovascular Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
Dai Asada
Affiliation:
Cardiovascular Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
Suguru Tarui
Affiliation:
Cardiovascular Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
Yoshinori Miyahara
Affiliation:
Cardiovascular Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
Kozo Ishino
Affiliation:
Cardiovascular Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
Takashi Soga
Affiliation:
Child Medical Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
*
Author for correspondence: T. Fujii, MD, PhD, Cardiovascular Center, Showa University Northern Yokohama Hospital, 35-1 Chigasakichuo, Tuzuki-ku, Yokohama City, Kanagawa 224-8503, Japan. Tel: +81 45 949 7000; Fax: +81 45 949 7117; E-mail: takanari@nn.iij4u.or.jp
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Abstract

Background and purpose

Static balloon atrial septostomy is a widely accepted intervention for children with CHD. Successful surgical palliation is creating increasing numbers of adult CHD patients who need subsequent left heart intervention requiring transseptal access. In these patients, the interatrial septum is usually thick and fibrotic because of a previous open heart surgery or catheter intervention, and conventional transseptal puncture may be unsuccessful. Static balloon atrial septostomy to access the left atrium may facilitate intervention via the interatrial septum in such situations. The purpose of this study was to investigate the usefulness and the safety of static balloon atrial septostomy, and the evolution of an iatrogenic atrial septal defect post procedure in adult CHD.

Methods

We retrospectively reviewed six procedures in five adults with CHD and collected demographic characteristics, details of the procedures, clinical outcome, and size changes of the iatrogenic atrial septal defect.

Results

The mean age at the time of the procedure was 35 years. The intended primary interventions were pulmonary vein isolation, stenting for pulmonary vein obstruction, and catheter ablation for focal atrial tachycardia. All static balloon atrial septostomies were effective, and the left heart interventions were successfully achieved via transseptal sheaths. There were no major complications associated with the static balloon atrial septostomy. There were no adverse clinical outcomes related to iatrogenic atrial septal defect, and the size of the defects regressed over time in all cases.

Conclusions

Static balloon atrial septostomy can be a safe and useful technique in adult CHD patients needing left heart procedures. The thick interatrial septum found in postoperative patients may reduce the risk of persistent iatrogenic atrial septal defect.

Keywords

CHDstatic balloon atrial septostomytransseptal punctureFontan procedurecatheter ablation
Type
Original Article
Information
Cardiology in the Young , Volume 28 , Issue 10 , October 2018 , pp. 1116 - 1121
Copyright
© Cambridge University Press 2018 

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