Restrictive Atrial Communication in Tricuspid Atresia With Minimal Duct-Dependent Pulmonary Circulation in a Newborn

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OBJECTIVES: To present ductal stenting and balloon atrial septostomy as minimally invasive alternatives to initial surgical palliation in cases of tricuspid atresia with restrictive foramen ovale and ductus arteriosus. KEY STEPS: Retrograde DA access was achieved via the femoral artery. A stent was deployed in the DA. Balloon atrial septostomy was performed under echocardiographic guidance by advancing a catheter via the femoral vein through the foramen ovale. Balloon inflation created a 1 cm interatrial communication. POTENTIAL PITFALLS: Complications such as ductal spasm or stent thrombosis and balloon rupture or cardiac trauma during balloon atrial septostomy are rare and can be minimized with precise technique and imaging guidance. TAKE-HOME MESSAGES: Early identification of restrictive atrial communication and the determination of the effectiveness of pulmonary blood flow in tricuspid atresia are vital for preventing significant hemodynamic compromise. Ductal stenting with atrial septostomy is a viable, less invasive alternative to surgical shunt as first-stage palliation in newborns with duct-dependent tricuspid atresia.

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