Published: 2021-06-24

Emergency atrial septostomy with nasogastric tube through umbilical venous route in neonates with critical congenital heart defects

Mallesh Kariyappa, Varun Govindarajan, Anil Kumar Hanumanna, Ashwini Harohalli Nagarasaiah, Meghana Jagadish


Neonates born with critical duct dependent congenital heart diseases acutely deteriorate in first few days after birth when physiological conduits which allow for mixing blood close. Balloon Atrial septostomy is performed on emergency basis in such neonates to create a right to left intracardiac shunt, until a definitive surgery is performed, but requires a cardiac intervention setup. In settings where advanced cardiac interventions are not available, we propose an alternative approach for atrial septostomy using nasogastric feeding tube through umbilical venous route, under echocardiographic guidance. Feeding tube gradually inserted into the umbilical vein, reaches the right atrium, following which it is thrust into the atrial septum at the location of foramen ovale, perforating it to create an emergency conduit between the atria. We performed the above procedure in a neonate with dTGA at our NICU setup, with partially successful outcome. We propose this method as an alternative, safe, simple and cost effective procedure, though not definitive, in resource limited settings for emergency stabilisation of neonates with critical duct dependent heart defects.


Feeding tube, Atrial septostomy, Umbilical vein, Congenital heart disease, Neonates

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Rashkind WJ, Miller WW. Creation of an atrial septal defect without thoracotomy. A Palliative Approach to Complete Transposition of the Great Arteries. JAMA. 1966;196:991-2.

Feltes TF, Bacha E, Beekman RH, Cheatham JP, Feinstein JA, Gomes AS, et al. Indications for cardiac catheterization and intervention in pediatric cardiac disease: a scientific statement from the American Heart Association. Circulation. 2011;123(22):2607-52.

Reichenberger F, Pepke ZJ, Neil K, Parameshwar J, Shapiro LM. Atrial septostomy in the treatment of severe pulmonary arterial hypertension. Thorax. 2003;58(9):797-800.

Abinader E, Zeltzer M, Riss E. Transumbilical atrial septostomy in the newborn. Am J Dis Child. 1970;119:354.

Allan LD, Leanage R, Wainwright R, Joseph MC, Tynan M. Balloon atrial septostomy under two dimensional echocardiographic control. Br Heart J. 1982;47:41-3.

Baker EJ, Allan LD, Tynan MJ, Jones OD, Joseph MC, Deverall PB. Balloon atrial septostomy in the neonatal intensive care unit. Br Heart J. 1984;51:377-8.

Boehm W, Emmel M, Sreeram N. Ballon atrial septostomy: history and technique. Images Paediatr Cardiol. 2006;8(1):8-14.

Parsons CG, Astley R, Burrows FG, Singh SP. Transposition of great arteries: a study of 65 infants followed for 1 to 4 years after balloon septostomy. Br Heart J. 1971;33:725-31.