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Factors associated with outcome of Congenital Heart Disease patients who underwent balloon atrial septostomy at the Philippine Heart Center.


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Department of Pediatric Cardiovascular Medicine - Philippine Heart Center


Introduction: Balloon atrial septostomy was described as, "a technique for producing an atrial septal defect without thoracotomy or anesthesia. It can be performed in any cardiac catheterization laboratory". BAS survival rates approached to 97 %. However, despite the increase in survival rates from 20 years ago the following outcomes wereamong the most commonly encountered complications such as vascular injury, cardiac perforation, bleeding, seizure, arrhythmia and death.

Methods: The list and medical record of patients who underwent BAS from January 2006 to December 2016 were obtained. The following variables were obtained from their records: demographic data, clinical and laboratory data, echocardiographic findings and cardiac catheterization findings. Outcomes (vascular injury, cardiac perforation, bleeding, seizure, arrhythmia, death)were obtained from their records within 24 hours.

Results: Fifty patients were enrolled. Half of the patients presented with oxygen saturation below 60 % and majority of them needed prostaglandin to keep the ductus arteriousus patent. Twenty six of the patients had metabolic acidosis probably due to severe hypoxemia. Majority of patient was diagnosed to have tricuspid valve atresia (30 %) and pulmonary valve atresia (30 %). Most of the patients had established interatrial communication post BAS with a minimum of 5 mm size.The frequency of the outcome associated with the procedures were as follows from the highest to the lowest; blood loss that requires transfusion (32%), death (24%), vascular injury (6%), seizure (6%), and arrhythmia (2%). There was no cardiac perforation reported.

Conclusion: As the result of this study showed patients should be started on prostaglandin and correction of metabolic imbalance is important since majority of those with outcome were patients with metabolic acidosis. Using smaller sheath and catheters will help minimize vascular injury and blood loss. All patients should be referred to pediatric cardiovascular anesthesia to ensure better control of environment for the patient. Patients should have standby blood products in case of blood loss.

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Philippine Heart Center Medical Library CRF.R.001.16 Fulltext Print Format

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