Atrial septostomy is a procedure addressing specific heart conditions, primarily involving the heart’s upper chambers. It creates or enlarges an opening in the wall separating the atria, aiming to improve blood flow and oxygenation. It serves as a temporary measure to stabilize a patient’s condition, particularly in newborns and infants, before definitive treatments.
What is Atrial Septostomy?
Atrial septostomy creates a small opening in the atrial septum, the muscular wall dividing the heart’s left and right upper chambers (atria), allowing for the mixing of oxygen-rich and oxygen-poor blood. The procedure is also known as balloon atrial septostomy or the Rashkind procedure.
The goal of this intervention is to improve blood circulation and increase oxygen levels. While providing immediate relief, atrial septostomy is a palliative measure, addressing symptoms and stabilizing the patient.
Why it is Performed
Atrial septostomy is performed for congenital heart defects or conditions impairing proper blood flow and oxygenation. One common reason is dextro-Transposition of the Great Arteries (d-TGA), a birth defect where major arteries leaving the heart are reversed. In d-TGA, oxygen-poor blood circulates to the body while oxygenated blood cycles back to the lungs, leading to low oxygen levels. The septostomy allows oxygenated blood to mix with deoxygenated blood, improving oxygen levels until corrective surgery.
The procedure is also indicated for severe pulmonary hypertension, a condition with high blood pressure in the lung arteries that can strain the right side of the heart. Creating a hole in the atrial septum can act as a “safety valve,” decompressing the overloaded right ventricle and improving blood flow by allowing some blood to bypass the lungs. It may also be used in single ventricle defects or severe hypoxemia, helping manage blood flow and temporarily increase oxygen levels.
How the Procedure Works
Atrial septostomy is a catheter-based procedure, often performed in a cardiac catheterization laboratory. It involves accessing the heart through a large vein, most commonly in the groin or, in infants, sometimes the umbilical vein. A thin, flexible catheter with a balloon at its tip is then guided through blood vessels into the right atrium and across the atrial septum into the left atrium.
Once the catheter is positioned in the left atrium, the balloon is inflated with a small amount of dilute radiopaque solution and quickly pulled back into the right atrium. This action tears or enlarges the opening in the atrial septum, allowing for improved blood mixing. The balloon is then deflated, and the catheter is removed.
Recovery and What to Expect
Following an atrial septostomy, patients are monitored closely in a hospital setting, often in an intensive care unit, for 24 to 48 hours. Medical staff continuously track vital signs: blood pressure, heart rate, and oxygen saturation. Supplemental oxygen may be provided as needed, and any mild chest discomfort is managed with medication.
Patients usually experience immediate improvements in oxygen levels and a reduction in symptoms like cyanosis. Ongoing medical management and often definitive corrective surgery will be required. Follow-up appointments assess the new opening’s effectiveness and monitor for complications.