Balloon Atrial Septostomy

Equipment:

• Yellow Line x 1
• 7 Fr Pediatric Sheath (Miller) x 1 or
• 6 Fr Pediatric Sheath (Tyschak) x 1
• 20g Leader Catheter x 2
• An additional pressure line may be needed therefore attach the yellow line to # 3 transducer and insert the 20g leader catheter into the left femoral vein using the seldinger technique.

Balloons:

• Miller septostomy balloon 5 Fr x 1 or
• Tyschak balloon 5 Fr x 1

To inflate these balloon,s a diluted contrast and saline solution of 1:8 is used. Draw up 1ml of contrast and 7 ml of saline in a 10-mlleur lock syringe.

Preparation:

A TYSHAK balloon will go through a 6 Frsheath whereas a MILLER balloon requires a 7Fr. The MILLER balloon is the most common but it is not available nowadays. To prepare the Miller balloon, remove the inner stiletto. Do not discard as it may be needed to give support to the catheter as it crosses the septum. Attach a 10 ml leur locking syringe with diluted contrast to the inflation port and apply negative pressure for a few seconds, then release the pressure. The air apace inside the balloon will fill with the diluted contrast. Repeat this a few times until no air comes out of the balloon when negative pressure is applied. The balloon is now ready to use. To prep, the TYSHAK balloon, attach a 10 mlleur locking syringe with diluted contrast to the inflation port (this will have a blue market) and apply negative pressure for a few seconds, then release the pressure. The air space inside the balloon will fill with the diluted contrast. Repeat this a few times until no air comes out of the balloon when negative pressure is applied. Flush the center lumen. A 0.021 wire may be used through the center lumen.

Procedure:

The septostomy balloon is inserted into the sheath on negative pressure across the PFO into the LA. The balloon may need to be preshaped with a stylet. Inflate the balloon to the desired amount (3-5 ml) and lock the balloon. The inflated balloon will be pulled across the septum with a quick jerk. Deflate the balloon immediately so that the IVC is not occluded. This procedure may need to be repeated 3-4 times until opening is of the desired size. Remove
the balloon on negative pressure. Replace the GL catheter and measure saturation and pressures.

Post Procedure:

The Sao2 should improve when the procedure is completed, Take an ABG sample and remove the lines as required. The arterial line may be left in-situ if the patient is in a PCICU bed and PCICU has invasive pressure line with a monitor.

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