Haemodynamic consequences of atrial septostomy without thoracotomy in an infant with transposition of the great arteries

Transposition of the great arteries. Results of palliation by balloon atrioseptostomy in thirty-one infants

A nonsurgical method of creating atrial septal defects using a balloon catheter has been reviewed, and important procedural and technical details have been presented. The results of balloon atrioseptostomy in 31 infants with transposition of the great arteries have been reported and compared with those from the surgical creation of atrial septal defects. All 31 patients survived balloon atrioseptostomy without complications; 26 of them (84%) had effective immediate palliation, and 22 (71%) are long-term survivors. These results demonstrate that effective palliation of transposition of the great arteries, with or without associated ventricular septal defect, can be provided rapidly and safely by balloon atrioseptostomy. All patients with transposition and a large ventricular septal defect should have balloon atrioseptostomy and may also need pulmonary artery banding. For some of these patients banding may be postponed safely for many months, may occur spontaneously, or may be avoided completely.

Atrioseptostomy by the balloon catheter technique requires neither sedation nor general anesthesia, and obviates the need for thoracotomy and cardiotomy. The rapidity with which it can be performed makes it particularly advantageous for the desperately hypoxic newborn with transposition of the great arteries who may be considered too sick to withstand major surgery.

The surgical relief of transposition of the great vessels in infancy

The necessity for palliative surgery in transposition of the great vessels is indicated and the basic haemodynamics of the condition are outlined. The clinical picture of infants with transposition is divided into three types, and a method of surgical treatment is suggested for the two most common types. Our technique of investigation and treatment is described and the reasons for our choice of therapy are discussed. The results of cases operated upon are presented.

Haemodynamic effects of balloon septostomy in tricuspid atresia

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