The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on endovascular atrial septostomy.
The main indication for this procedure is transposition of the great arteries, an uncommon congenital cardiac anomaly in which the aorta arises from the right ventricle and the pulmonary trunk arises from the left ventricle. Less commonly, septostomy is carried out in children with other cyanotic congenital abnormalities.
Endovascular atrial septostomy is a procedure that is used to enlarge the foramen ovale. A catheter is passed through a large vein, usually in the groin, into the right atrium and through the foramen ovale to the left atrium. A balloon at the end of the catheter is inflated and pulled back into the right atrium, so enlarging the foramen ovale. Static balloon atrial septostomy is a procedure that is used to enlarge an inter-atrial communication when simple balloon septostomy is unsuccessful or contraindicated. It is usually used in older children or adults with a thick septum in whom there is no atrial communication. The septum is cut using a catheter with a blade at its end. The balloon is then used to enlarge the opening in the septum. The procedure aims to prolong survival until definitive surgery can be performed.
Without a treatment to make a connection between the right and left atria, most babies would not survive. The only babies likely to survive for even a few weeks without septostomy are those with a congenital ventricular septal defect. There is no reliable alternative to septostomy procedures in neonates. Definitive surgery is usually done several months after septostomy.