Effectiveness of the Rashkind Procedure in Transposition of the Great Arteries in Infants
The immediate and long-term efficacy of the balloon atrial septostomy (BAS) was appraised in a series of 43 patients with transposition of the great arteries. Early effectiveness was gauged by changes in oxygen saturation and atrial pressures, and by balloon catheter measurement of the interatrial opening immediately following BAS. BAS was initially effective in 31 cases. In 20 patients the size of the interatrial opening was measured by balloon catheter from three months to three years after initially successful BAS. In 13 of these the opening was less than 12 mm; 7 subsequently required surgical septectomy, and each of the remaining 6 had a ventricular septal defect. In the other 7, the opening was greater than 12 mm; none have required surgical septectomy. A total of 13 patients required late septectomy, with only one death. In contrast, there was a 40% (17/44) surgical mortality with surgical septectomy in a similar group of patients between 1959 and 1966. It is concluded that balloon atrial septostomy is initially effective and relatively safe, but that, particularly in those with intact ventricular septum, surgical septectomy is often required. Balloon catheter measurement of the interatrial opening has been helpful in predicting the necessity for surgical septectomy.
- © 1971 American Heart Association, Inc.