What is an atrial septostomy?
Your heart has two upper chambers, called the atria, separated by a thin wall. An atrial septostomy is a procedure in which a small opening is made in that wall so that blood can flow from the one side to the other. In certain conditions the pressure on one side of the heart becomes dangerously high, or blood cannot mix properly, and this small opening acts as a relief valve that takes the strain off the heart and improves the amount of oxygen reaching your body.
Why is it done?
The procedure is used when the pressure in the right side of the heart and the lung arteries is severely raised, or in certain heart conditions present from birth where blood needs to mix between the two sides. It does not cure the underlying condition, but it can relieve breathlessness, dizziness and fainting, help the heart cope, and in some patients serve as a bridge to further treatment or transplantation. Your cardiologist will only recommend it after weighing the expected benefit against your own risks.
What happens on the day?
The procedure is done in the catheterisation laboratory, which looks like a small operating theatre with X-ray equipment. You will be given a drip and medicine to relax you, and the skin over a vein in your groin is numbed with local anaesthetic. A thin, soft tube (a catheter) is passed through that vein up to the heart, guided by X-ray and often by ultrasound of the heart. A fine needle or wire is used to cross the wall between the two upper chambers, and a small balloon is then inflated to widen the opening to exactly the size your cardiologist wants. Pressures and oxygen levels are measured throughout to confirm the effect. It usually takes one to two hours, and you are awake but comfortable.
What to expect afterwards
Afterwards you lie flat for a few hours so that the small puncture in the groin can seal, and your heart rhythm, blood pressure and oxygen level are monitored. Many patients notice that they breathe more easily within a day or two, although the oxygen level in the blood may be slightly lower than before because some blood now bypasses the lungs. Most people go home after one to three days. You should avoid heavy lifting and strenuous exercise for about a week, and keep the groin site clean and dry. A follow-up appointment with an ultrasound of the heart is arranged to check the opening.
Possible complications
Serious problems are uncommon, but no procedure is without risk. You may develop bruising, bleeding or tenderness where the catheter entered the groin. Less often the opening can become too large, causing the oxygen level to drop too far, or it can close again over time and need repeating. Rarely the wall of the heart or a blood vessel can be injured, causing bleeding around the heart that needs to be drained, or a disturbance of heart rhythm, stroke or a reaction to the contrast dye can occur. In very sick patients the procedure itself carries a risk to life, and your cardiologist will discuss your own situation frankly with you and your family beforehand.
This information does not replace a consultation. Please discuss your own risks and options with your cardiologist.