A balloon atrial septostomy, also known as the Rashkind procedure, is a minimally invasive procedure for newborns with specific congenital heart defects. It addresses problems with blood circulation and oxygenation. The procedure uses a catheter with a balloon tip to enlarge a natural opening between the heart’s upper chambers, the atria. This allows oxygen-poor and oxygen-rich blood to mix, which is necessary for survival until a more permanent surgical correction can be performed.
Medical Conditions Requiring the Procedure
Certain congenital heart defects prevent a newborn’s body from receiving enough oxygenated blood. The most common condition is dextro-Transposition of the Great Arteries (d-TGA), where the aorta and pulmonary artery are switched. This creates two separate circulatory systems, one with oxygen-poor blood and one with oxygen-rich blood. Without a way for these systems to mix, the body’s tissues are deprived of oxygen.
The procedure addresses this by enlarging the foramen ovale, a natural hole between the atria. This larger opening allows oxygen-rich blood from the left atrium to mix with oxygen-poor blood in the right atrium. This mixed blood is then pumped to the body, resolving the severe oxygen deprivation known as cyanosis, which gives the skin a bluish tint. While d-TGA is the most frequent reason, other cyanotic heart conditions may also require this procedure.
Other conditions include pulmonary atresia, where the pulmonary valve is not formed, and tricuspid atresia, where the tricuspid valve is missing. Another is Hypoplastic Left Heart Syndrome (HLHS), where the left side of the heart is severely underdeveloped. In some cases of HLHS, the atrial septum is too restrictive, preventing proper blood flow and causing a backup of blood in the lungs. For these infants, creating or enlarging an atrial opening improves blood flow and stability.
The Balloon Atrial Septostomy Procedure
A balloon atrial septostomy is a cardiac catheterization performed by a pediatric interventional cardiologist. The procedure can be done at the infant’s bedside in the neonatal intensive care unit (NICU), using an echocardiogram for guidance. More technically challenging cases may be performed in a cardiac catheterization laboratory with advanced imaging equipment.
The cardiologist inserts a thin, flexible tube called a catheter into a large vein, such as the umbilical vein in the navel or the femoral vein in the groin. The catheter has a deflated balloon at its tip and is guided into the right atrium of the heart. Using echocardiogram imaging, the physician navigates the catheter tip through the foramen ovale into the left atrium.
Once the catheter tip is in the left atrium, the balloon is inflated. The inflated balloon is then pulled back through the opening into the right atrium. This action tears the atrial septum tissue, creating a larger hole. The balloon is then deflated, and the catheter is withdrawn from the body.
Recovery and Hospital Care
Following the procedure, the infant is monitored in the NICU or a cardiac intensive care unit (CICU). A successful septostomy results in a visible change in the baby’s skin color from a bluish tint to pink. This indicates that more oxygenated blood is circulating. Monitoring equipment will also show higher oxygen saturation levels.
The baby will be connected to monitors that track heart rate, breathing, and blood pressure, allowing the medical team to assess their stability. The goal during this period is to allow the infant to rest, grow, and gain strength. This prepares the infant for the next stage of treatment.
The baby will remain in the intensive care setting for some time after the procedure. The medical team will manage medications, provide nutritional support, and ensure the infant is comfortable. Consistent monitoring allows for any potential complications to be identified and managed swiftly.
Procedural Risks and Long-Term Outlook
While a balloon atrial septostomy is generally safe, it carries some uncommon risks. Potential complications include an irregular heartbeat (arrhythmia) from the irritation of heart tissue. There is also a small risk of damage to nearby heart structures, like the valves or the atrium wall. Complications related to the catheter at the insertion site can also occur.
A balloon atrial septostomy is not a permanent cure for the underlying congenital heart defect but is a palliative or “bridge” procedure. Its purpose is to resolve poor blood oxygenation and stabilize the newborn. This stability allows the infant to grow bigger and stronger, making them a better candidate for corrective surgery.
For infants with d-TGA, the septostomy allows them to stabilize before an arterial switch operation, which corrects the position of the great arteries. This surgery happens within a few weeks of birth. For other defects like HLHS, the septostomy is the first in a series of staged surgical procedures. The procedure enables the infant to survive until a permanent surgical solution is possible.