Septostomy

Overview

Infants born with congenital heart defects can survive until they undergo corrective surgery thanks to a life-saving procedure known as septostomy. Septostomy involves expanding or creating a hole in the infant’s heart, allowing oxygen-rich and oxygen-poor blood to mix. This procedure is also referred to as the Rashkind operation or balloon atrial septostomy because it primarily involves the baby’s upper heart chambers, called atria.

During septostomy, a healthcare provider uses a needle to puncture the skin and introduces a catheter. Within the catheter, there’s a balloon that enlarges a naturally occurring hole in the baby’s heart. This opening enables blood with lower oxygen levels to mix with blood that is rich in oxygen. As a result, the baby’s body can start circulating partially oxygenated blood after it leaves the heart. Without this pathway, the baby’s body would only pump blood with low oxygen levels.

It’s important to note that septostomy is not considered open-heart surgery; rather, it serves as a temporary solution to bridge the gap between birth and the necessary corrective surgery. Healthcare providers developed septostomy to promptly provide babies with specific heart defects with increased oxygen levels to support their vital functions.

Reasons for undergoing the procedure

Infants with specific cyanotic heart defects may require a septostomy. These defects prevent low-oxygen blood from reaching the infant’s lungs, where it should become oxygenated. As a result, the infant’s tissues do not receive enough oxygen, leading to a bluish skin color due to oxygen deprivation, known as cyanosis. Severe cyanosis demands immediate medical attention due to its potentially harmful effects.

In some cases, babies with these issues may receive medications like prostaglandin E1 to enhance their oxygen supply. Another option for infants in need of immediate oxygen support until surgery is a septostomy.

A septostomy can be beneficial for infants with cyanotic heart defects, serving as a temporary solution for conditions like tricuspid atresia or dextro-transposition of the great arteries that disrupt blood flow to the lungs. However, surgery is ultimately necessary to address these cardiac defects.

Risk

Every surgery carries some risk for infants with severe heart defects. Some evidence suggests that strokes in infants may be associated with septostomy. It’s unclear if the operation causes the stroke. It’s possible that the primary cause is the lack of oxygen caused by certain heart defects. To completely comprehend the connection between infant strokes and septostomy, more research on the subject is required.

However, newborns that do not receive medical attention may not survive. One week after delivery, newborns with d-TGA had a 70% chance of surviving without medicine or a septostomy. After a month, that probability decreases to 50%, and after a year, it reduces to 10%.

Before the procedure

Obtaining specific information from the healthcare provider is crucial when determining whether an infant will undergo a septostomy. This is essential because the needs and heart anatomy of infants born with congenital heart defects can vary significantly. Some infants may require unique treatment approaches due to a combination of different abnormalities. Therefore, it’s essential to consult the infant’s healthcare provider for in-depth information about the procedure’s preparation and the specific criteria for its success.

During the procedure

A catheterization lab or the neonatal intensive care unit (ICU) of a hospital are the places where an atrial septostomy surgery is performed.

A large vein in the infant’s skin is accessed by an interventionist, a cardiologist with specialized training in cardiac catheterization. This is typically applied in the groin region. The umbilical cord can provide access in some cases.

A catheter, which is a flexible tube with a balloon at the tip, is used in place of the needle. The catheter is guided into the infant’s blood vessels and into their heart by the interventionist using echocardiography imaging. The infant’s right atrium is then reached by the catheter. The interventionist then forces it to enter their left atrium by pushing it through the foramen ovale.

The interventionist then pulls the balloon back into their right atrium by inflating it at the catheter’s tip. This movement enlarges the foramen ovale. In rare instances, the interventionist might first need to create a hole in the patient’s septum with a catheter that has a blade at the tip before inserting the balloon.

After the procedure

Generally, an atrial septostomy is considered successful if certain requirements are fulfilled:

• There should be a significant improvement in the infant’s artery oxygen levels—at least 10%.
• If the septal opening widens by at least 33% in comparison to its pre-procedural dimensions, the surgery is considered successful.
• Maintaining small differences in blood pressure between the left and right atria indicates a positive outcome.

Outcome

A balloon atrial septostomy can be a lifesaving procedure for a baby when a heart defect hinders the sufficient intake of oxygen. This procedure assists a baby in obtaining increased oxygen and surviving long enough for surgery.

The benefits of this intervention can vary depending on the individual’s unique circumstances. Healthcare providers consider several factors when determining the need for a septostomy, including the risks associated with delaying surgery and the overall health of the infant.

Approximately 94% of infants who undergo a balloon atrial septostomy successfully survive the procedure. Subsequently, they require surgical intervention to address their heart defects. Babies born with critical congenital heart defects necessitate continuous medical attention following their corrective surgeries. This ongoing care involves regular follow-up appointments, diagnostic imaging examinations, and vigilant monitoring. It’s important to recognize that each baby’s prognosis varies based on the specific heart defects they have and their overall health condition. If your child has received treatment for a congenital heart defect, it is advisable to have a discussion with their healthcare provider to gain insight into what lies ahead in their healthcare journey.