You must have been very scared when the doctor told you that your little one had a congenital heart defect. Then, they might have told you that a procedure called a septostomy would be needed to save your baby's life. It's normal to feel overwhelmed and confused when you hear these words. But don't worry. Today, we're going to talk about what it is, why it's done, and how it's done in a very simple way that you can understand.
What exactly is a septostomy?
Simply put, a septostomy is a special procedure that helps babies with certain congenital heart conditions survive until they are ready for major surgery to correct the condition. Some people also call it a 'Balloon Atrial Septostomy'.
Imagine, there is a small wall between the two upper chambers of our heart (atria). In this treatment, a small hole that is naturally present in that wall is made slightly larger using something like a balloon.
This is not a major open-heart surgery . It is done as a temporary solution to keep the baby alive while they are being prepared for major surgery.
When this hole gets bigger, blood with more oxygen (good blood) and blood with less oxygen (bad blood) start to mix together. Then, some of this mixed blood travels throughout the baby's body. Otherwise, only blood without oxygen travels throughout the baby's body, which is very dangerous for life.
What kind of baby needs this treatment?
Some babies are born with certain heart defects. Because of these defects, the oxygen-poor blood in the body does not go to the lungs and is not cleaned. Then the baby's tissues do not get the oxygen they need. We call this condition 'cyanosis'. You may have seen some babies with blue skin. That is the main symptom of this. This is a very dangerous condition, and it needs to be treated immediately.
This procedure, called septostomy, is most often used in two types of heart disease.
| Heart condition | Simple explanation |
|---|---|
| d-Transposition of the Great Arteries (d-TGA) | What happens in this is that the two main blood vessels that carry blood out of the heart (the aorta and the pulmonary artery) are switched. It's like two main roads are switched. As a result, oxygenated blood goes back to the lungs, and deoxygenated blood goes throughout the body. |
| Tricuspid Atresia | In this case, a valve on the right side of the heart (tricuspid valve) is not formed properly. Therefore, blood cannot flow from the upper chamber of the heart to the lower chamber, the passage is blocked. |
What is this 'natural hole' called the Foramen Ovale?
This is a very strange thing. While in the womb, every baby has a small hole in the wall (septum) between the right and left sides of their heart. It's called a foramen ovale.
When they're in the womb, babies don't breathe through their lungs. They get their oxygen from the mother's placenta, through the umbilical cord. This oxygenated blood comes from the right side of the baby's heart, goes straight through that hole to the left side. From there, it goes throughout the body. That means when they're in the womb, the blood doesn't go to the lungs.
However, as soon as the baby is born, the lungs start working. Then there is no need for that hole. Therefore, the hole closes naturally a few days after birth.
So, for the baby with the heart disease mentioned above, the biggest problem is when this hole closes. Because, as long as that hole is there, some oxygenated blood mixes with the deoxygenated blood and goes into the body. As soon as it closes, that path is lost and the baby doesn't get enough oxygen. What a septostomy does is to open up that closing or closed hole again and make it a little bigger.
That means, although a hole in the heart is usually a disease, in a special case like this, that hole is what saves the baby's life .
How is a septostomy done?
This is done in a special room in the hospital's cardiac unit (catheterization lab) or neonatal intensive care unit (NICU). It is performed by a cardiologist who has received special training for this.
1. Preparation: The baby is given the necessary medication to keep him calm and pain-free.
2. Inserting the catheter: Usually, a small needle is used to pierce a large blood vessel in the baby's groin, and a thin, flexible tube (catheter) is inserted through it. This tube has a small balloon at the end. Sometimes this is also done through a tube in the umbilical cord.
3. Moving to the heart: The doctor looks at a scanning machine, such as an 'echocardiogram', and carefully guides the tube through the blood vessels all the way to the heart.
4. Enlargement of the hole: The tube is inserted into the right atrium of the heart, and then into the left atrium through the foramen ovale. Then, the balloon at the end of the tube is inflated and pulled back to the right side. The hole is then stretched and enlarged.
5. End: When the work is finished, remove the air from the balloon and carefully remove the tube.
This entire process usually takes less than an hour.
How do you know if this is successful? What are the benefits and risks?
Doctors determine whether treatment is successful based on things like:
- The oxygen level in the baby's blood increases by at least 10% compared to before.
- The hole in the heart becomes at least a third larger than it was before.
- The large difference in blood pressure between the right and left atria of the heart disappears.
The main advantage is that this saves the baby's life. A baby who cannot get oxygen in any other way has the chance to survive until major surgery.
Speaking of risks , there are risks with any medical procedure. Especially for babies with serious heart conditions like this, anything is risky. Some studies have found a possible link between this treatment and stroke, but it hasn't been proven definitively. Perhaps the risk isn't due to the treatment itself, but rather to the lack of oxygen to the body due to the heart disease.
But the most important thing is that the risk of not having this treatment is much greater than the risk of doing it . If a baby with heart disease like this is not treated quickly, it is very difficult to save their life.
What is the baby's future like after treatment?
A very high percentage of babies who undergo a septostomy, 94%, successfully complete the procedure. After that, major surgery (e.g., an arterial switch operation) is performed to repair the heart defect at the appropriate time. The success rate of these surgeries is currently very high, at 97-98%.
Even after surgery, your baby will need ongoing medical care. You will need to keep up with your doctor's appointments, have scans, and take medications. Every baby is different, so your doctor can give you the best information about your baby's progress.
I understand the fear and anxiety you feel when you have to do something like this to your baby. But remember, medical science is very advanced today. There is a team of skilled doctors and nurses to take care of your baby. Don't be afraid to ask them any questions or doubts you have.
Take-Home Message
- Septostomy is a life-saving treatment that helps babies with congenital heart disease survive until major surgery is performed.
- This is not open-heart surgery.
- This involves enlarging a naturally occurring hole in the heart (foramen ovale) with a balloon, allowing oxygenated and deoxygenated blood to mix.
- The success and safety of this treatment are very high.
- Talk to the medical team treating your baby about any concerns or doubts you may have. They are always ready to help you.
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