title: New transcatheter techniques for creation or enlargement of atrial septal defects in infants with complex congenital heart disease.
abstract: OBJECTIVE
  To describe a series of 8 consecutive infants (5 with transposition of the great arteries [TGA] and 3 with hypoplastic left heart syndrome [HLHS]) who underwent nonconventional septostomy techniques.
  
  
  BACKGROUND
  For some complex congenital heart defects, an unrestrictive atrial septal defect (ASD) is essential to achieve an adequate cardiac output and/or systemic saturation. In some scenarios, the use of conventional septostomy techniques may be technically difficult, hazardous, and/or ineffective.
  
  
  METHODS
  Use of transhepatic approach, cutting balloons, and radiofrequency perforation with stenting of the atrial septum.
  
  
  RESULTS
  The size of the ASD and the oxygen saturation increased in all patients with no major complications. In those with TGA, the ASDs were considered to be of good size at the arterial switch operation. Two of the 3 patients with hybrid palliation for HLHS have developed some degree of obstruction within the interatrial stent over 2-3 months. At surgery, the stents were found to be secured within the septum with one showing significant fibrous ingrowth after uneventful removal. The other had some nonobstructive ingrowth.
  
  
  CONCLUSIONS
  Creation or enlargement of ASDs in infants using new nonconventional transcatheter techniques is feasible, safe, and effective, at least in the short-to-mid-term follow-up. Infants with TGA seem to benefit the most because the procedure results in satisfactory clinical stability for subsequent early surgical intervention. In infants with HLHS palliated by a hybrid approach, stent implantation to the atrial septum seems to buy enough time to bring them to the phase II safely despite progressive in-stent obstruction.
authors.affiliation: Pediatric Cardiology Division, Hospital do Coração da Associação Sanatório Sírio, São Paulo, SP, Brazil. cacpedra@uol.com.br
authors.forename: Carlos A C
authors.initials: CA
authors.lastname: Pedra
authors.forename: Juliana R
authors.initials: JR
authors.lastname: Neves
authors.forename: Simone R F
authors.initials: SR
authors.lastname: Pedra
authors.forename: Carlos R
authors.initials: CR
authors.lastname: Ferreiro
authors.forename: Ieda
authors.initials: I
authors.lastname: Jatene
authors.forename: Tâmara M
authors.initials: TM
authors.lastname: Cortez
authors.forename: Marcelo
authors.initials: M
authors.lastname: Jatene
authors.forename: Luis Carlos B
authors.initials: LC
authors.lastname: Souza
authors.forename: Renato
authors.initials: R
authors.lastname: Assad
authors.forename: Valmir F
authors.initials: VF
authors.lastname: Fontes
mesh_terms: D006328:Cardiac Catheterization / Q000379:methods*; D002404:Catheterization / Q000379:methods; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000628:therapy*; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000628:therapy*; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011677:Punctures; D015641:Radiography, Interventional; D012189:Retrospective Studies; D014188:Transposition of Great Vessels / Q000628:therapy*; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional