Balloon Atrial Septostomy in Congenital Heart Disease　– Reply –

We thank Gopalakrishnan et al for their interest in our study.¹ First of all, details of the anatomy of each child were not provided because we focused on the efficacy and safety of static balloon atrial septostomy with double balloon technique. As mentioned, the Nikaidoh procedure was considered to be an important option in case 1.^2,3 However, the patient’s body weight was only 6.4 kg and the pulmonary valve annulus was too small for commissurotomy.⁴ Although conduit repair was required, homograft is rarely available in Japan. Practically, a hand-made synthetic conduit with valve is the only option for right ventricular outflow reconstruction. In our institution, more than 10 kg of body weight is considered to be appropriate timing for conduit repair. Intraventricular was another option, but the size of the ventricular septal defect was considered to be borderline for reconstruction of the left ventricular outflow tract and conduit repair was still necessary. Consequently, adequate atrial communication was necessary until the child attained greater body size. We believe static balloon atrial septostomy with double balloon technique has the potential to avoid surgical septal creation in infants.

• Hisashi Sugiyama, MD
• Kazuto Fujimoto, MD
• Tetsuko Ishii, MD
• Toshio Nakanishi, MD
• Hideshi Tomita, MD
• Pediatric Cardiology, Tokyo Women’s Medical University, Tokyo (H.S., T.I., T.N.);
• Cardiovascular Center, Showa University Northern Yokohama Hospital, Yokohama (K.F., H.T.), Japan

(Released online March 8, 2016)

References

• 1.    Sugiyama  H,  Fujimoto  K,  Ishii  T,  Nakanishi  T,  Tomita  H. Impact of novel balloon catheter on static balloon atrial septostomy with double balloon technique in infants with congenital heart disease. Circ J 2015; 79: 2367–2371.
• 2.    Nikaidoh  H. Aortic translocation and biventricular outflow tract reconstruction: A new surgical repair for transposition of the great arteries associated with ventricular septal defect and pulmonary stenosis. J Thorac Cardiovasc Surg 1984; 88: 365–372.
• 3.    Honjo  O,  Kotani  Y,  Bharucha  T,  Mertens  L,  Caldarone  CA,  Redington  AN, et al. Anatomical factors determining surgical decision-making in patients with transposition of the great arteries with left ventricular outflow tract obstruction. Eur J Cardio-Thorac Surg 2013; 44: 1085–1094.
• 4.    Sakamoto  K,  Ota  N,  Murata  M,  Tosaka  Y,  Ide  Y,  Tachi  M, et al. Modified Nikaidoh procedure with double-root translocation in a 1-year-old boy. Ann Thorac Surg 2014; 97: 1055–1057.