I can only imagine the whirlwind of emotions you’re feeling. One moment, you’re welcoming your beautiful baby into the world, and the next, a team of doctors is speaking in hushed, urgent tones. You might hear words like “congenital heart defect” or notice a faint bluish tint to your baby’s skin. It’s terrifying, and it’s okay to feel overwhelmed. In these critical moments, you might also hear the term septostomy. This procedure can sound scary, but I want to walk you through what it is, because for some tiny hearts, it is an absolute lifeline.
A septostomy isn’t a permanent fix, and it’s not open-heart surgery. Think of it as a crucial bridge—a temporary measure that helps your baby stay safe and strong enough for a future repair surgery. It gives us the precious time we need.
What is a Septostomy, Exactly?
In the simplest terms, a septostomy is a procedure designed to improve the mixing of blood inside your baby’s heart. It’s also known as a balloon atrial septostomy or the Rashkind procedure.
It’s done by a specially trained cardiologist, called an interventionist. The procedure is “percutaneous,” which just means we go through the skin using a very fine needle, usually in the groin area where there’s a large vein. We then guide a thin, flexible tube called a catheter up to the heart. This catheter has a tiny, deflated balloon on its tip.
Using imaging like an echocardiogram as a map, we guide this catheter into the heart’s upper right chamber (the right atrium) and through a small, natural opening that all babies have before birth. Once on the other side, we inflate the balloon and gently pull it back. This action carefully stretches that natural opening, allowing oxygen-poor blood and oxygen-rich blood to mix together. This newly mixed, partly-oxygenated blood can then travel out to your baby’s body, which is exactly what we need to happen.
Why Would My Baby Need This Procedure?
A septostomy is most often needed for babies born with what we call “cyanotic” heart defects. This is a medical term for conditions that cause a baby’s skin to have a blue or purple tint, a sign called cyanosis. It happens when there isn’t enough oxygen in the blood circulating through their body.
This lack of oxygen is dangerous and needs to be addressed right away. The goal of a septostomy is to correct this imbalance, even temporarily. Two common conditions that may require this procedure are:
| The Condition | What It Means for Your Baby’s Heart |
|---|---|
| Dextro-transposition of the great arteries (d-TGA) | The two main arteries leaving the heart are swapped. This creates two separate “circuits”—one where oxygen-poor blood keeps going to the body, and another where oxygen-rich blood just cycles back to the lungs. They aren’t mixing. |
| Tricuspid atresia | The valve that should let blood flow from the upper right chamber to the lower right chamber of the heart didn’t form. Instead, a solid wall of tissue blocks the path, preventing blood from getting to the lungs to pick up oxygen properly. |
The Lifesaving Role of a Tiny Hole
It sounds strange, doesn’t it? We usually think of a “hole in the heart” as a problem we need to fix. But in these specific situations, a small hole is actually a lifesaver.
Before a baby is born, they don’t use their lungs. They get all their oxygen from their parent through the placenta and umbilical cord. To make this work, every fetus has a small opening in the wall (the septum) between the heart’s upper chambers. This little passageway is called the foramen ovale.
After birth, when a baby takes their first breath, their lungs kick into gear. Blood flow is rerouted to the lungs to get oxygen, and this passageway is no longer needed. It usually closes on its own.
But for a baby with a condition like d-TGA, the foramen ovale staying open for a little while allows some of that crucial mixing of blood. When it starts to close, the baby’s oxygen levels can drop dangerously. The septostomy procedure is our way of reopening or enlarging this very hole, turning a “defect” into a temporary solution that keeps your baby stable.
Weighing the Benefits and Risks
I know you’re worried. Any procedure, no matter how small, feels huge when it involves your child. Let’s be honest about it.
The single greatest advantage is that a balloon atrial septostomy can, and does, save lives. It buys the critical time your baby needs to grow a little stronger before undergoing the major surgery that will permanently repair their heart.
Like any medical procedure, it’s not without risks. Babies with serious heart defects are already very fragile. Some research has noted a possible link with strokes, but it’s not clear if the procedure is the cause, or if it’s related to the underlying lack of oxygen from the heart defect itself. We have to weigh this small potential risk against the near-certainty of what happens without intervention. For a baby with d-TGA, the chance of survival drops dramatically within the first week of life without treatment. This procedure gives them that chance.
After the Procedure and Looking Ahead
A septostomy is typically a very successful procedure, with about 94% of babies getting through it well. Afterward, you should see the color in your baby’s skin improve as their blood oxygen levels rise.
This is the first major step on their journey. The next step will be the main surgical repair. For babies with d-TGA, this is usually the arterial switch operation (ASO), where a surgeon moves the arteries back to their correct positions. These major surgeries also have very high success rates, with 97-98% of babies doing well.
Your child will need lifelong care from a cardiologist to monitor their heart health, but the outlook is very positive. They can go on to lead full, active lives. We will be with you every step of the way.
Take-Home Message
- A septostomy is a minimally invasive procedure, not open-heart surgery. It’s a temporary measure to stabilize your baby.
- It’s used for specific congenital heart defects that cause low blood oxygen levels (cyanosis).
- The goal is to enlarge a natural opening in the heart to allow oxygen-rich and oxygen-poor blood to mix.
- Think of it as a life-saving bridge that gives your baby time to become strong enough for a full surgical repair.
- Your baby’s care team is there to answer every single question you have. Please, don’t hesitate to ask.
This journey is a marathon, not a sprint. Hearing your baby needs any kind of heart procedure is one of the hardest things a parent can go through. But you are not alone in this. Your medical team, your family, and a whole community of other heart parents are here to support you. We’re in this together.