Balloon atrial septostomy in hypoplastic left heart syndrome with restrictive atrial septum

Yosuke Fukushima, Kenji Baba, Maiko Kondo, Yoshihiko Kurita, Takahiro Eitoku, Yusuke Shigemitsu, Kenta Hirai, Hirokazu Tsukahara, Tatsuo Iwasaki, Shingo Kasahara, Yasuhiro Kotani, Shin-ichi Ohtsuki

Research output: Contribution to journalArticle

Abstract

Background: Rashkind balloon atrial septostomy (BAS) can be challenging in infants with hypoplastic left heart syndrome (HLHS) and small atrial septal defect (ASD). Methods: We retrospectively reviewed all infants with HLHS who underwent surgery and BAS between January 2006 and December 2015. The infants were divided into three groups: no BAS; catheter BAS; and open AS. Infants who underwent catheter BAS were divided into two groups based on atrial septal anatomy: standard and complex. Results: Of the 70 patients, 57 (81%) underwent Glenn surgery. Subsequently, a significant difference in survival was observed: 86% (44/51), 91% (10/11), and 25% (2/8) in the no BAS, catheter BAS, and open AS groups, respectively (P = 0.0002). No significant difference was seen between the no BAS and the catheter BAS groups (P = 1.0). In the 56 patients who underwent catheterization after surgery, no intergroup differences in mean pulmonary artery pressure, pulmonary vascular resistance, or pulmonary artery index were found. We classified catheter BAS into standard (n = 5) and complex (n = 5) based on ASD location, and septum thickness. All patients in the standard group underwent complete Rashkind BAS, but in the complex group, only one patient underwent complete Rashkind BAS, with the remaining requiring initial static BAS (P = 0.048). Following septostomy, ASD size, ASD flow, and percutaneous oxygen saturation (SpO 2 ) were not significantly different between the two groups. Conclusions: Catheter BAS is effective in infants with HLHS and a restrictive atrial septum. Infants with standard or complex atrial septum can achieve equivalent outcomes despite more patients often requiring static BAS.

Original languageEnglish
JournalPediatrics International
DOIs
Publication statusPublished - Jan 1 2019

Fingerprint

Atrial Septum
Hypoplastic Left Heart Syndrome
Catheters
Atrial Heart Septal Defects
Pulmonary Artery
Catheterization
Vascular Resistance
Anatomy
Oxygen
Pressure
Survival

Keywords

  • atrial septal defect
  • atrial septum
  • catheterization
  • hypoplastic left heart syndrome
  • prognosis

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

@article{e04e795abc7c4aae8c24a021672ae142,
title = "Balloon atrial septostomy in hypoplastic left heart syndrome with restrictive atrial septum",
abstract = "Background: Rashkind balloon atrial septostomy (BAS) can be challenging in infants with hypoplastic left heart syndrome (HLHS) and small atrial septal defect (ASD). Methods: We retrospectively reviewed all infants with HLHS who underwent surgery and BAS between January 2006 and December 2015. The infants were divided into three groups: no BAS; catheter BAS; and open AS. Infants who underwent catheter BAS were divided into two groups based on atrial septal anatomy: standard and complex. Results: Of the 70 patients, 57 (81{\%}) underwent Glenn surgery. Subsequently, a significant difference in survival was observed: 86{\%} (44/51), 91{\%} (10/11), and 25{\%} (2/8) in the no BAS, catheter BAS, and open AS groups, respectively (P = 0.0002). No significant difference was seen between the no BAS and the catheter BAS groups (P = 1.0). In the 56 patients who underwent catheterization after surgery, no intergroup differences in mean pulmonary artery pressure, pulmonary vascular resistance, or pulmonary artery index were found. We classified catheter BAS into standard (n = 5) and complex (n = 5) based on ASD location, and septum thickness. All patients in the standard group underwent complete Rashkind BAS, but in the complex group, only one patient underwent complete Rashkind BAS, with the remaining requiring initial static BAS (P = 0.048). Following septostomy, ASD size, ASD flow, and percutaneous oxygen saturation (SpO 2 ) were not significantly different between the two groups. Conclusions: Catheter BAS is effective in infants with HLHS and a restrictive atrial septum. Infants with standard or complex atrial septum can achieve equivalent outcomes despite more patients often requiring static BAS.",
keywords = "atrial septal defect, atrial septum, catheterization, hypoplastic left heart syndrome, prognosis",
author = "Yosuke Fukushima and Kenji Baba and Maiko Kondo and Yoshihiko Kurita and Takahiro Eitoku and Yusuke Shigemitsu and Kenta Hirai and Hirokazu Tsukahara and Tatsuo Iwasaki and Shingo Kasahara and Yasuhiro Kotani and Shin-ichi Ohtsuki",
year = "2019",
month = "1",
day = "1",
doi = "10.1111/ped.13716",
language = "English",
journal = "Pediatrics International",
issn = "1328-8067",
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TY - JOUR

T1 - Balloon atrial septostomy in hypoplastic left heart syndrome with restrictive atrial septum

AU - Fukushima, Yosuke

AU - Baba, Kenji

AU - Kondo, Maiko

AU - Kurita, Yoshihiko

AU - Eitoku, Takahiro

AU - Shigemitsu, Yusuke

AU - Hirai, Kenta

AU - Tsukahara, Hirokazu

AU - Iwasaki, Tatsuo

AU - Kasahara, Shingo

AU - Kotani, Yasuhiro

AU - Ohtsuki, Shin-ichi

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Rashkind balloon atrial septostomy (BAS) can be challenging in infants with hypoplastic left heart syndrome (HLHS) and small atrial septal defect (ASD). Methods: We retrospectively reviewed all infants with HLHS who underwent surgery and BAS between January 2006 and December 2015. The infants were divided into three groups: no BAS; catheter BAS; and open AS. Infants who underwent catheter BAS were divided into two groups based on atrial septal anatomy: standard and complex. Results: Of the 70 patients, 57 (81%) underwent Glenn surgery. Subsequently, a significant difference in survival was observed: 86% (44/51), 91% (10/11), and 25% (2/8) in the no BAS, catheter BAS, and open AS groups, respectively (P = 0.0002). No significant difference was seen between the no BAS and the catheter BAS groups (P = 1.0). In the 56 patients who underwent catheterization after surgery, no intergroup differences in mean pulmonary artery pressure, pulmonary vascular resistance, or pulmonary artery index were found. We classified catheter BAS into standard (n = 5) and complex (n = 5) based on ASD location, and septum thickness. All patients in the standard group underwent complete Rashkind BAS, but in the complex group, only one patient underwent complete Rashkind BAS, with the remaining requiring initial static BAS (P = 0.048). Following septostomy, ASD size, ASD flow, and percutaneous oxygen saturation (SpO 2 ) were not significantly different between the two groups. Conclusions: Catheter BAS is effective in infants with HLHS and a restrictive atrial septum. Infants with standard or complex atrial septum can achieve equivalent outcomes despite more patients often requiring static BAS.

AB - Background: Rashkind balloon atrial septostomy (BAS) can be challenging in infants with hypoplastic left heart syndrome (HLHS) and small atrial septal defect (ASD). Methods: We retrospectively reviewed all infants with HLHS who underwent surgery and BAS between January 2006 and December 2015. The infants were divided into three groups: no BAS; catheter BAS; and open AS. Infants who underwent catheter BAS were divided into two groups based on atrial septal anatomy: standard and complex. Results: Of the 70 patients, 57 (81%) underwent Glenn surgery. Subsequently, a significant difference in survival was observed: 86% (44/51), 91% (10/11), and 25% (2/8) in the no BAS, catheter BAS, and open AS groups, respectively (P = 0.0002). No significant difference was seen between the no BAS and the catheter BAS groups (P = 1.0). In the 56 patients who underwent catheterization after surgery, no intergroup differences in mean pulmonary artery pressure, pulmonary vascular resistance, or pulmonary artery index were found. We classified catheter BAS into standard (n = 5) and complex (n = 5) based on ASD location, and septum thickness. All patients in the standard group underwent complete Rashkind BAS, but in the complex group, only one patient underwent complete Rashkind BAS, with the remaining requiring initial static BAS (P = 0.048). Following septostomy, ASD size, ASD flow, and percutaneous oxygen saturation (SpO 2 ) were not significantly different between the two groups. Conclusions: Catheter BAS is effective in infants with HLHS and a restrictive atrial septum. Infants with standard or complex atrial septum can achieve equivalent outcomes despite more patients often requiring static BAS.

KW - atrial septal defect

KW - atrial septum

KW - catheterization

KW - hypoplastic left heart syndrome

KW - prognosis

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U2 - 10.1111/ped.13716

DO - 10.1111/ped.13716

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C2 - 30339315

AN - SCOPUS:85062723804

JO - Pediatrics International

JF - Pediatrics International

SN - 1328-8067

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