Bedside Transthoracic 2D Echo-Guided Blade Atrial Septostomy: First Reported Case in the Philippines

Dexter Eugene D. Cheng and Maycibel D. Magadaeg-Capero

Section of Pediatric Cardiology, Department of Pediatrics, College of Medicine and
Philippine General Hospital, University of the Philippines Manila

A nonrestrictive interatrial communication is mandatory in some patients with complex cyanotic heart disease. Up to the present time, Park blade atrial septostomy with a Park blade catheter is performed only under fluoroscopic guidance. We successfully monitored only under transthoracic 2-dimensional (2D) echocardiography (TTE), in a 7-week-old infant with d-Transposition of Great Arteries (d-TGA), a restrictive patent foramen ovale (PFO), and small ventricular septal defect (VSD), who presented with severe hypoxemia. TTE confirmed the position of the blade before and during pullback to the right atrium, followed by balloon septoplasty. There was an adequate enlargement of the interatrial communication with subsequent improvement in the oxygenation of the infant. This is the first reported case of the performance of blade atrial septostomy as a bedside TTE guided procedure here in the Philippines.

Key Words: blade atrial septostomy, d-TGA, PFO, fluoroscopy, 2-dimensional echocardiogram