title: New technique of off-pump atrial septostomy for complex congenital cardiac anomalies.
abstract: OBJECTIVE
  Atrial septostomy is essential for palliation of some complex congenital cardiac anomalies, such as transposition of the great arteries and left-/right-sided atrioventricular valve stenosis or atresia. Conventionally, balloon atrial septostomy is done in neonates. Beyond the neonatal period, surgical septostomy is done using cardiopulmonary bypass and can lead to increased morbidity and mortality. We report a new technique of atrial septostomy without cardiopulmonary bypass and its follow-up.
  
  
  METHODS
  Eleven cases underwent atrial septostomy without using cardiopulmonary bypass from January 2009 to June 2010. Median age of patients was 7 months (2-12 months) and median weight was 6.3 kg (range 4.5-10 kg). Surgical septostomy was performed through the right atrial appendage with a Tubb's dilator, aided by intra-operative transesophageal echocardiography. Atrial septal defect (ASD) less than 5mm was enlarged with a Kerrison bone punch and then dilated with a Tubb's dilator. Associate procedures performed were off-pump Glenn in seven cases, pulmonary artery (PA) banding in three cases, and shunt with PA band in one case.
  
  
  RESULTS
  All the restricted ASDs were successfully enlarged with adequate interatrial shunting without any gradient. Echocardiography revealed no evidence of introduction of air or particulate emboli, and no tricuspid valve injury or heart block. There was no postoperative mortality. Follow-up ranged from 1 to 18 months (median 11 months). Echocardiography showed good PA band gradient/well-functioning Glenn shunt and unobstructed ASD with good oxygen saturation.
  
  
  CONCLUSIONS
  This technique demonstrates the surgical feasibility of a beating-heart atrial septostomy. It avoids the adverse effects of cardiopulmonary bypass, reduces morbidity, and has no mortality. It is safe, economical, and easily reproducible. To our knowledge, this technique has not been reported in literature so far.
authors: Department of Paediatric Cardiac Surgery, Paediatric Cardiology and Cardiac Anaesthesiology, Innova Children's Heart Hospital, Tarnaka, Secunderabad 500017, Andhra Pradesh, India. drpramodreddy@yahoo.com
authors: Pramod Reddy
authors: PR
authors: Kandakure
authors: Gouthami
authors: G
authors: Vejendla
authors: Nagarajan
authors: N
authors: Ramodoss
authors: Usha
authors: U
authors: Rani
authors: Shiva
authors: S
authors: Prasad
authors: Srinivas
authors: S
authors: Chakravarthy
authors: Ivatury Mrityunjaya
authors: IM
authors: Rao
authors: Samba Murthy
authors: SM
authors: Kona
mesh_terms: D054087:Atrial Septum / Q000000981:diagnostic imaging / Q000601:surgery*; D002315:Cardiopulmonary Bypass; D004106:Dilatation / Q000295:instrumentation / Q000379:methods; D017548:Echocardiography, Transesophageal / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging / Q000601:surgery*; D006344:Heart Septal Defects, Atrial / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D007223:Infant; D008297:Male; D018084:Ultrasonography, Interventional / Q000379:methods