The Clinical Application of Real-Time Three Dimensional Color Echocardiography to Monitor Balloon Atrial Septostomy in Cyanotic Neonates with Congenital Heart Disease and Transposition of the Great Ar

The purpose of this study was to evaluate the clinical application of realtime three-dimensional color echocardiography (RT-3DE) to guide transcatheter atrial septostomy in the intensive care unit (ICU) in neonates with congenital heart disease and transposition of the great arteries. Between Sept. 2004 and Sept. 2007, a total of 6 neonates were diagnosed with transposition of the great arteries and critical cyanosis requiring transcatheter atrial septostomy. The procedure was performed at the bedside in the ICU using conventional transeptal catheters in all six cases guided by RT-3DE once the catheter was advanced to the diaphragm level. The transcatheter atrial repository was successfully performed with guidance by RT-3DE in all of the 6 neonates. There were no complications except in 1 patient who developed sepsis 3 days after the procedure. The critical steps during transcatheter atrial septostomy include advancing the balloon catheter into the left atrium, positioning and full expansion of the balloon, sudden withdrawal of the catheter from the left to the right atrium with the balloon inflated, abrupt cessation of withdrawal of the balloon catheter to avoid damaging the vena cava, and balloon deflation. All of these steps were monitored and guided by RT-3DE at the bedside. This new approach allows immediate visualization of the balloon catheter in the atrial chamber without further image reconstruction that is required with conventional two-dimensional echocardiography. It may further decrease the risk of this procedure.