Name of the Procedure:

Atrial Septectomy or Septostomy; Transvenous Method, Balloon (e.g., Rashkind Type) (includes Cardiac Catheterization)

Summary

Atrial septectomy or septostomy, performed using a transvenous method with a balloon catheter, is a minimally invasive medical procedure aimed at creating or enlarging an opening in the atrial septum, the wall between the heart's two upper chambers.

Purpose

Medical Condition or Problem Addressed:

This procedure is commonly performed to treat congenital heart defects such as atrial septal defects (ASD) or to relieve severe cyanosis (lack of oxygen in blood) in newborns with certain types of congenital heart diseases.

Goals or Expected Outcomes:

• Improve oxygenation of the blood
• Enhance blood flow between the atria
• Provide symptomatic relief and stabilize the patient's condition

Indications

Specific Symptoms or Conditions:

• Severe cyanosis in newborns due to congenital heart defects like transposition of the great arteries (TGA)
• Other complex congenital heart anomalies that require urgent inter-atrial communication

Patient Criteria:

• Newborns or infants with diagnosed congenital heart defects
• Patients with inadequate oxygenation levels or poor blood mixing between the heart chambers

Preparation

Pre-procedure Instructions:

• Fasting for a specified period before the procedure
• Adjustments to current medications as advised by the healthcare provider

Diagnostic Tests or Assessments:

• Echocardiogram
• Blood tests
• Electrocardiogram (ECG)
• Chest X-ray

Procedure Description

Step-by-Step Explanation:

1. Anesthesia: The patient, usually a newborn or infant, is given general anesthesia.
2. Access: A catheter is inserted through a vein, typically in the groin area.
3. Navigation: The catheter is carefully threaded through blood vessels into the heart and towards the atrial septum.
4. Balloon Inflation: A special balloon attached to the catheter is inflated to create or enlarge an opening in the atrial septum.
5. Completion: The balloon is deflated and removed, and the catheter is withdrawn.

Tools and Equipment:

• Cardiac catheter with balloon attachment
• Imaging guidance tools like fluoroscopy and echocardiography

Anesthesia:

• General anesthesia for patient comfort and immobility during the procedure

Duration

The procedure typically takes about 1 to 2 hours.

Setting

Performed in a hospital, specifically in a catheterization laboratory (cath lab) or pediatric cardiac interventional suite.

Personnel

• Pediatric cardiologist or interventional cardiologist
• Anesthesiologist
• Specialized nurses and technicians

Risks and Complications

Common Risks:

• Bleeding or bruising at the catheter insertion site
• Infection

Rare Risks:

• Arrhythmias (irregular heartbeats)
• Damage to the heart or blood vessels
• Allergic reactions to contrast dye or anesthesia

Management:

Most complications can be managed with medications or further interventions if necessary.

Benefits

• Immediate improvement in oxygenation levels
• Stabilization of the patient's condition
• Potentially lifesaving in critical congenital heart defects

Recovery

Post-procedure Care:

• Monitoring of vital signs and heart function in a cardiac intensive care unit (CICU)
• Medications for pain control and infection prevention

Expected Recovery Time:

• Initial recovery within a few days
• Full recovery varies, usually observing until the patient is stable

Restrictions and Follow-up:

• Limited physical activity initially
• Follow-up appointments for echocardiograms and assessments

Alternatives

Other Treatment Options:

• Open-heart surgery for more permanent correction of the defect
• Medication management in milder cases

Pros and Cons Compared to the Described Procedure:

• Open-heart surgery: More invasive, longer recovery but provides a more permanent solution
• Medication management: Less invasive, but may not be effective in severe cases

Patient Experience

During the Procedure:

• The patient will be under general anesthesia and will not feel any discomfort.

After the Procedure:

• Mild soreness at the catheter insertion site
• Close monitoring and support in a hospital setting
• Pain management with prescribed medications for comfort