It is difficult to put into words what a mother or father feels when they learn that their newborn baby has a serious heart problem. But today, medicine has advanced a lot. Sometimes, there are small but very important treatments that can keep a baby alive until major surgery is performed. Today, we are talking about one such life-saving treatment. This is called a septostomy.
Simply put, what is a septostomy?
Septostomy is a life-saving procedure that helps babies with congenital heart defects survive until they can have major surgery to repair their heart. It is also called a 'balloon atrial septostomy'.
This is not open-heart surgery. What happens here is that a doctor inserts a small needle through the baby's skin and passes a very thin tube (catheter) through it to the heart. At the end of this tube is a small balloon. This balloon is used to enlarge a small hole that is naturally present in the baby's heart.
This hole allows oxygen-rich blood and oxygen-poor blood to mix . Then, some oxygen-rich blood circulates throughout the baby's body. If this treatment is not done, only very low-oxygen blood circulates in the baby's body. This is very dangerous for the baby's life.
Remember, this is not major heart surgery. This is just a temporary solution to keep the baby safe until he is ready for major surgery.
What kind of baby needs this treatment?
Some babies with congenital heart diseases have a bluish color to their skin. In medical terms, this is called cyanosis . This happens because the body is not getting enough oxygen from the blood. This means that the oxygen-poor blood goes straight to the lungs and is not purified, but instead travels throughout the body. This condition is very dangerous and requires emergency medical treatment .
Septostomy is most often needed for babies with cyanotic heart disease. There are two main heart conditions for which this treatment is most commonly used.
| Heart condition | Simply explained |
|---|---|
| Dextro-transposition of the great arteries (d-TGA) | This is when the two main blood vessels that carry blood out of the heart (the pulmonary artery and the aorta) are switched. It's like two water pipes in a house being switched. As a result, oxygen-poor blood goes to the body, and oxygen-rich blood goes back to the lungs. This prevents the body from getting oxygen. |
| Tricuspid atresia | In this condition, the tricuspid valve, which is responsible for blood flowing from the right atrium to the right ventricle, does not function properly. Instead, a thickened tissue forms, completely blocking the flow of blood. This prevents blood from reaching the lungs to get oxygen. |
What is the story of this small hole called the Foramen Ovale?
To understand this, we have to go back a little to the time when the baby was in the mother's womb.
When a baby is in the womb, the baby's lungs don't work. The baby gets the oxygen it needs from the mother through the umbilical cord. So, this oxygenated blood is sent directly to the body without going to the lungs, and this foramen ovale is a natural small opening in the heart. This is located in the wall between the two upper chambers (atria) of the heart.
After the baby is born, the lungs start working. Then, since this little opening is no longer needed, it usually closes on its own.
So why is this hole important for septostomy treatment?
For those babies with heart disease that we talked about earlier, who turn blue, this hole called the foramen ovale helps them survive for a few days after birth. Through it, some oxygen-rich blood mixes with oxygen-poor blood and enters the body.
However, when this hole starts to close on its own, that opening closes. Then the baby's life becomes very dangerous. That's when septostomy treatment becomes necessary. What the doctors do is use that balloon to make the hole in the foramen ovale that is about to close a little bigger and keep it open . Then the baby can be kept alive until major surgery is done.
Sometimes, if this hole is completely blocked, doctors can use a special bladed tube to create a new hole. It may sound strange to think of making a hole in the heart, but it may be the only way to save the lives of babies like this.
How is this septostomy treatment done?
This treatment is performed either in a special laboratory (catheterization lab) in the hospital's cardiac unit or in the neonatal intensive care unit (Neonatal ICU). It is performed by a cardiologist who has received special training for this purpose.
1. Gaining access: First, the doctor inserts a small needle into a large blood vessel in the baby's groin area. Sometimes this can be done through the umbilical cord.
2. Insertion of the catheter: The needle is then removed, and a thin tube (catheter) with a balloon is inserted through the hole into the blood vessel.
3. Moving to the heart: The doctor carefully guides this tube through the blood vessels to the heart while watching the images on an echocardiogram .
4. Enlargement of the hole: Once the tube is in the right atrium of the heart, it is passed through the foramen ovale into the left atrium. Then, the balloon at the end of the tube is inflated and pulled back to the right side. This pulling enlarges the small hole.
5. End of treatment: Once the hole is large enough, the balloon is deflated and the tube is carefully removed.
This entire process is done while giving the baby the necessary anesthesia and painkillers, and carefully monitoring the baby.
How do doctors determine if the treatment is successful?
Doctors look at several factors to determine whether the treatment is successful.
- They check to see if the oxygen level in the baby's blood has increased by at least 10% .
- They check to see if the hole made in the heart has become at least 33% larger than it was before.
- We check to see if there is a significant difference in blood pressure between the right and left atriums of the heart.
If one or more of these factors are met, the treatment is considered successful.
What are the benefits and risks of this?
Advantages
The biggest advantage of this treatment is that it can save a baby's life . A baby who is deprived of oxygen due to a heart condition can be given oxygen quickly and given the chance to live until major surgery.
Risks
As with any medical treatment, there are risks. Any treatment for babies with serious heart disease carries risks. Some studies have shown that this treatment can cause strokes. However, it is not yet clear whether this is due to the treatment itself or to the lack of oxygen to the body due to the heart disease.
But the most important thing is that the risks of not treating this disease are much higher than the risks of treating it. Without treatment, a baby with a disease like d-TGA has a low chance of surviving a week, around 30%.
What will the baby's future be like after treatment?
Only 94% of babies who undergo septostomy survive . They then have to undergo major surgery to correct their heart condition.
For example, babies with d-TGA undergo an operation called an Arterial Switch Operation (ASO) shortly after birth. This involves cutting the two switched blood vessels and reconnecting them properly. Between 97% and 98% of babies recover well after this operation.
After major surgery like this, your baby will need ongoing medical care. This means seeing your doctor at regular intervals, getting tests, and taking good care of your baby. Since every baby is different, your doctor can give you the best information about your baby's future.
Things you need to know as a parent
It's normal to feel scared, worried, and have a lot of questions when you learn that your little one has a serious condition. It's also very difficult to be away from your baby while they're in the hospital. The medical staff understands your feelings.
- Don't be afraid to ask questions: Ask the doctor or nursing staff any questions you have about the medicine your baby is being given, the treatment, or what will happen next. If you don't understand, ask them to explain it again simply.
- Seek support: Talking to other parents who have had similar experiences can be a great source of encouragement. Ask your doctor about support groups.
These types of heart conditions may be rare, but you are not alone. A septostomy can be the first and most important step in your baby's life. With the right medical care and your love and care, you can be sure to give your baby a healthy future.
Take-Home Message
- Septostomy is not open-heart surgery. It is a temporary treatment that is performed before major surgery to save the lives of babies with serious heart conditions.
- This involves enlarging a natural hole in the heart (foramen ovale), allowing more oxygenated and less oxygenated blood to mix.
- This treatment is most commonly used for cyanotic heart conditions such as d-TGA and tricuspid atresia.
- Treatment is very effective, and the risks are very low. The risks of not treating it are much higher.
- As a parent, don't be afraid to ask the medical staff about anything you don't understand. They are always ready to help you.
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