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      A simple and fast technique for radiofrequency-assisted perforation of the atrial septum in congenital heart disease

      case-report

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          Abstract

          Radiofrequency (RF) assisted perforation of the atrial septum was performed successfully in three infants using a 0.035” RF wire deployed through a Williams right posterior catheter. Balloon atrial septoplasty was performed over the 0.035” RF wire in two of them, shortening the procedural time.

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          The hypoplastic left heart syndrome with intact atrial septum: atrial morphology, pulmonary vascular histopathology and outcome.

          Jack Rychik, Jonathan J. Rome, Margaret H. Collins … (1999)
          The purpose of this study was to investigate the outcome in infants with hypoplastic left heart syndrome and intact atrial septum and to evaluate the relationship of atrial morphology, left atrial decompression pathway and lung histopathology to outcome. In the hypoplastic left heart syndrome, severe restriction at the atrial level results in marked systemic hypoxemia after birth. Infants with intact atrial septum may be at high risk for mortality after Norwood operation. Of 316 infants with hypoplastic left heart syndrome seen at our center over a 6.5-year period, 18 (5.7%) had intact atrial septum. Medical records and echocardiograms were reviewed. On echocardiography, three types of intact atrial septal morphology were identified: 1) large left atrium, thick prominent septum secondary with thin septum primary adherent (type A, n = 12); 2) small left atrium with thick, muscular atrial septum (type B, n = 4), and 3) giant left atrium, thin atrial septum with severe mitral regurgitation (type C, n = 2). Seven infants had left atrial decompression pathways that were severely obstructed (3/12 type A, 4/4 type B). Norwood operation was performed in 17 infants; one underwent emergency balloon atrial septostomy and died. Of six early survivors, all with type A atrial morphology and unobstructed decompression pathway, three died after subsequent cavopulmonary surgery. Lung histopathology revealed severely dilated lymphatics and "arterialization" of the pulmonary veins in those with the severest degree of obstruction to left atrial egress (type B atrial morphology). Despite aggressive intervention, outcome for infants born with hypoplastic left heart syndrome and intact atrial septum is poor. Maldevelopment of the pulmonary vasculature contributes to the high mortality seen. Atrial morphology can be used as a marker for the severity of pulmonary vascular disease.
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            The technique and safety of transseptal left heart catheterization: the Massachusetts General Hospital experience with 1,279 procedures.

            Andrew T. Smith, M A Roelke, I Palacios (1994)
            With the introduction of interventional procedures such as percutaneous mitral valvuloplasty and radiofrequency ablation of left-sided bypass tracts, there has been renewed interest in the technique of transseptal left heart catheterization. We review our experience with 1,279 transseptal catheterizations performed over the last 10 years. The most common indications for transseptal catheterization included direct measurement of left atrial pressure or access to the left ventricle in patients with prosthetic aortic or mitral valves, and in patients undergoing percutaneous mitral valvuloplasty. A total of 17 major complications occurred (1.3%), including cardiac tamponade (15 patients, 1.2%), systemic emboli (1 patient, 0.08%), and death secondary to aortic perforation (0.08%). We conclude that when performed by experienced operators, transseptal left heart catheterization is associated with low morbidity and mortality.
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              Clinical use of AcuNav diagnostic ultrasound catheter imaging during left heart radiofrequency ablation and transcatheter closure procedures.

              Jian-Fang Ren, Francis Marchlinski, David J Callans … (2002)
              AcuNav ultrasound catheter (UC) (10F, 5.5-10 MHz) has unique advantages for left heart imaging with its 4-way tip flexible maneuverability, maximal 16-cm intracardiac imaging depth, and Doppler and color flow imaging capability.
              Article 0 comments Cited 9 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Ann Pediatr Cardiol
                Journal ID (iso-abbrev): Ann Pediatr Cardiol
                Journal ID (publisher-id): APC
                Title: Annals of Pediatric Cardiology
                Publisher: Medknow Publications & Media Pvt Ltd (India )
                ISSN (Print): 0974-2069
                ISSN (Electronic): 0974-5149
                Publication date (Print): Jan-Apr 2016
                Volume: 9
                Issue: 1
                Pages: 39-41
                Affiliations
                [1]Department of Pediatrics, Cardiac Diagnostic and Interventional Unit, The Hospital for Sick Children, The Labatt Family Heart Centre, University of Toronto School of Medicine, Toronto, Ontario, Canada
                Author notes
                Address for correspondence: Dr. Rajiv R Chaturvedi, The Hospital for Sick Children, 555 University Ave, Toronto, Ontario, Canada M5G 1X8. E-mail: rajiv.chaturvedi@ 123456sickkids.ca
                Article
                Publisher ID: APC-9-39
                DOI: 10.4103/0974-2069.171405
                PMC ID: 4782466
                PubMed ID: 27011690
                SO-VID: 6425309a-4601-4e75-8115-6b51ad15b9fb
                Copyright © Copyright: © Annals of Pediatric Cardiology
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

                History
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Cardiovascular Medicine
                Keywords: congenital heart disease,intact atrial septum,radiofrequency perforation of interatrial septum
                Data availability:
                ScienceOpen disciplines: Cardiovascular Medicine
                Keywords: congenital heart disease, intact atrial septum, radiofrequency perforation of interatrial septum

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