Modified Septostomy in d-Transposition of Great Arteries With Aneurysmal and Intact Atrial Septum

A male term patient was delivered electively due to prenatal diagnosis of d-transposition of great arteries. Postpartum arterial saturation measured 65%. Transthoracic echo revealed an extremely aneurysmal atrial septum with no obvious atrial septal defect. Emergency Rashkind procedure was deemed necessary. Multiple attempts to advance the septostomy catheter to the left atrium resulted in tenting of the septum with no obvious interatrial flow. The aneurysmal septum was therefore advanced with caution and perforated within the left lower pulmonary vein under echocardiographic guidance. The patient tolerated the procedure well and a successful arterial switch operation was performed eight days later. Stabilization and perforation of an aneurysmal, intact atrial septum within the pulmonary vein may be a helpful maneuver to complete the Rashkind procedure.