title: Atrial septal stent implant: atrial septal defect creation in the management of complex congenital heart defects in infants.
abstract: OBJECTIVE
  Certain congenital heart defects require the creation of an unrestrictive atrial septal defect (ASD) to relieve atrial hypertension, to maintain systemic cardiac output, or to achieve adequate atrial mixing to improve systemic oxygen saturation. We describe a series of patients, ranging in age from 5 weeks to 17 months, in whom we implanted a stent across the atrial septum to create a lasting, unrestrictive interatrial communication.
  
  
  METHODS
  Five patients with left heart obstructive defects presented with severe left atrial hypertension. The patients weighed 3.5-10.1 kg. Patients 1 and 2 presented at 5 and 9 weeks of age, respectively. Patient 1 had a restrictive patent foramen ovale, and patient 2 had an intact atrial septum. Patients 3, 4, and 5 had previous cardiac surgery including atrial septectomy. At presentation, all patients were poor surgical candidates.
  
  
  RESULTS
  Using standard percutaneous technique, a premounted Palmaz-Genesis stent (Cordis Corporation) was implanted across the atrial septum in all 5 patients, using balloons ranging from 7 to 10 mm diameter. Each patient had a dramatic decrease in left atrial pressure and increased ASD diameter. All stented ASDs remained widely patent, confirmed by Doppler echocardiography, until elective surgical stent explant.
  
  
  CONCLUSIONS
  Patients presenting beyond the neonatal period with left heart obstructive defects and intact atrial septum or restrictive ASD present a challenging problem. We report a safe and effective technique for relief of left atrial hypertension in infants using premounted intravascular stents. All patients had immediate marked hemodynamic improvement.
authors: Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA.
authors: Glenn T
authors: GT
authors: Leonard
authors: Henri
authors: H
authors: Justino
authors: Karina M
authors: KM
authors: Carlson
authors: Joseph W
authors: JW
authors: Rossano
authors: Steven R
authors: SR
authors: Neish
authors: Charles E
authors: CE
authors: Mullins
authors: Ronald G
authors: RG
authors: Grifka
mesh_terms: D016279:Atrial Function, Left; D054087:Atrial Septum / Q000601:surgery*; D003490:Cyanosis / Q000601:surgery; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D006973:Hypertension / Q000601:surgery; D007223:Infant; D007231:Infant, Newborn; D019919:Prosthesis Implantation / Q000295:instrumentation*; D015607:Stents