Balloon atrial septostomy in dextro-transposition of the great arteries (D-TGA)

This figure illustrates BAS, which is a transcatheter procedure most commonly performed in newborns with D-TGA who have severe cyanosis due to inadequate atrial mixing. It can be performed at the bedside with echocardiographic guidance or in the cardiac catheterization laboratory with the use of both fluoroscopy and echocardiography. Central venous access is typically obtained through the umbilical or femoral vein. A balloon catheter is advanced through the IVC and into the right atrium. The balloon catheter is then advanced through the PFO into the left atrium (panel A). The balloon is then inflated (panel B) and pulled vigorously back across the atrial septum (panel C). This enlarges the atrial communication and improves intracardiac mixing. The procedure is repeated at least once, and then echocardiographic and hemodynamic assessments are performed to ensure adequate intracardiac mixing. If the procedure is successful, systemic oxygen saturation should begin to increase immediately.