Double “dynamic” balloon atrial septostomy. New modification of Dr. Rashkind’s technique for cases with thickened interatrial septum

José L. Colín-Ortiz, Department of Pediatric Cardiology, National Institute of Pediatrics, México City, México
Roberto Silva-Quijano, Department of Pediatric Cardiology, National Institute of Pediatrics, México City, México
Jorge A. Silva-Estrada, Department of Pediatric Cardiology, National Institute of Pediatrics, México City, México
Roberto I. Maldonado-Alonso, Department of Pediatric Cardiology, Hospital for the Poblano Child, Puebla, México
Ever Munive-Molina, Department of Pediatric Cardiology, Hospital for the Poblano Child, Puebla, México
Linda F. Pérez-Pérez, Department of Pediatric Cardiology, Hospital for the Poblano Child, Puebla, México
Rigoberto Zamudio-Meneses, Department of Pediatric Cardiology, Hospital for the Poblano Child, Puebla, México
Carlos A. Corona-Villalobos, Department of Pediatric Cardiology, National Institute of Pediatrics, México City, México
Hugo Cabrera-González, Department of Pediatric Cardiology, Hospital for the Poblano Child, Puebla, México
Roberto Tepatzi-Carranco, Department of Neonatology, Tlaxcala´s Children Hospital, Tlaxcala, México
Sylvia K. Sánchez-González, Department of Pediatric Cardiology, National Institute of Pediatrics, México City, México
Luis M. Garrido-García, Department of Pediatric Cardiology, National Institute of Pediatrics, México City, México
Alfredo Bobadilla-Aguirre, Department of Pediatric Cardiology, National Institute of Pediatrics, México City, México
Javier López-Terrazas, Department of Pediatric Cardiology, National Institute of Pediatrics, México City, México

Objectives: Balloon atrial septostomy (BAS) is a palliative procedure mainly for newborns with transposition of the great arteries, currently, this procedure has a class IA recommendation. However, in some cases, this procedure does not achieve an adequate interatrial defect, due mainly to a thickened interatrial septum, this situation led to the development of various techniques to tackle this problem. Therefore, we made a modification to the original technique using two balloons simultaneously instead of one. The objective of this study is to analyze the results of this new modification to the traditional technique (with one balloon) as an alternative for cases with thickened interatrial septum. Methods: A retrospective and descriptive study from May 2010 to December 2022 was conducted in three pediatric centers. Results: Six patients were identified (median age 35 days, median weight 3.4 kg, median size of atrial septal defect before procedure 2.6 mm). All patients underwent to this modification of the BAS with good results and without complications. The modification has some advantages: including to avoid the using of cutting devices or stent placement. In addition, we share the description of this new technique, titled: double “dynamic” BAS. Conclusion: This brief evidence shown that this modification of de original technique is easy, safe, and cost-effective for cases with a thickened interatrial septum.

Keywords: Balloon atrial septostomy. Transposition of great arteries. Thickened interatrial septum. Atrial septal defect.