Septostomy creates openings in the septum to connect chambers within an organ surgically or interventional.
Association with pediatric cardiology is common but it can also refer to other structures like the nasal septum.
Surgery improves blood flow in patients with congenital heart defects such as transposition of arteries or hypoplastic syndrome.
A hole in the atrial septum mixes blood to improve oxygen supply.
Types are as follows:
Balloon Atrial Septostomy (BAS)
Surgical Septostomy
BAS minimally invasive procedure for neonates with TGA was introduced in 1966. Balloon catheter expands foramen ovale or creates hole in atrial septum.
Open-heart surgery is necessary when balloon atrial septostomy is ineffective.
Indications
Congenital Heart Defects
Pulmonary Hypertension
Failure of Foramen Ovale to Close Adequately
Transposition of the Great Arteries
Hypoplastic Left Heart Syndrome
Nasal Obstruction
Sinus and Nasal Disorders
Contraindications
Irreversible Pulmonary Hypertension
Uncorrectable Coagulopathy
Infection or Sepsis
Inability to Access the Septum
Uncontrolled Systemic Conditions
Atrophic Rhinitis
Active Nasal
Severe Coagulopathy
Extensive Nasal Trauma
Outcomes
Equipment required
Fluoroscopy Unit
Echocardiography
Hemodynamic Monitoring
Vascular Access Equipment
Sheaths and Guidewires
Patient Preparation:
Evaluate patient’s health, comorbidities, reasons for procedure, and suitable septostomy target confirmation.
Both cardiac and nasal septostomy procedures may need sedation or anesthesia depending on patient age and complexity.
             Figure. Septostomy of heart
Cardiac Septostomy
For Balloon Atrial Septostomy:
Step 1: Balloon Inflation
The balloon is inflated with saline within the left atrium.
Step 2: Septal Tearing
Inflated balloon pulled back quickly through atrial septum. The process may be repeated as needed to achieve the desired defect size.
Step 3: Confirmation
Echocardiography is used to confirm the size and function of the septal defect.
For Surgical Septostomy:
The chest is opened, and the heart is accessed. A direct incision is made in the atrial septum to create an opening.
The chest is closed, and the patient is gradually off bypass.
Septostomy creates openings in the septum to connect chambers within an organ surgically or interventional.
Association with pediatric cardiology is common but it can also refer to other structures like the nasal septum.
Surgery improves blood flow in patients with congenital heart defects such as transposition of arteries or hypoplastic syndrome.
A hole in the atrial septum mixes blood to improve oxygen supply.
Types are as follows:
Balloon Atrial Septostomy (BAS)
Surgical Septostomy
BAS minimally invasive procedure for neonates with TGA was introduced in 1966. Balloon catheter expands foramen ovale or creates hole in atrial septum.
Open-heart surgery is necessary when balloon atrial septostomy is ineffective.
Congenital Heart Defects
Pulmonary Hypertension
Failure of Foramen Ovale to Close Adequately
Transposition of the Great Arteries
Hypoplastic Left Heart Syndrome
Nasal Obstruction
Sinus and Nasal Disorders
Irreversible Pulmonary Hypertension
Uncorrectable Coagulopathy
Infection or Sepsis
Inability to Access the Septum
Uncontrolled Systemic Conditions
Atrophic Rhinitis
Active Nasal
Severe Coagulopathy
Extensive Nasal Trauma
Fluoroscopy Unit
Echocardiography
Hemodynamic Monitoring
Vascular Access Equipment
Sheaths and Guidewires
Patient Preparation:
Evaluate patient’s health, comorbidities, reasons for procedure, and suitable septostomy target confirmation.
Both cardiac and nasal septostomy procedures may need sedation or anesthesia depending on patient age and complexity.
             Figure. Septostomy of heart
For Balloon Atrial Septostomy:
Step 1: Balloon Inflation
The balloon is inflated with saline within the left atrium.
Step 2: Septal Tearing
Inflated balloon pulled back quickly through atrial septum. The process may be repeated as needed to achieve the desired defect size.
Step 3: Confirmation
Echocardiography is used to confirm the size and function of the septal defect.
For Surgical Septostomy:
The chest is opened, and the heart is accessed. A direct incision is made in the atrial septum to create an opening.
The chest is closed, and the patient is gradually off bypass.
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