New way to create an ASD!

Here’s a report of a novel procedure that will hopefully come into use soon: creating (or enlarging) an Atrial Septal Defect (ASD) without breaking the skin.

I had a small ASD at the time of my first surgery but it needed to be larger. Back then (1967), ASDs had to be created or enlarged the old fashioned way – with a scapel. This was known as the Blalock-Hanlon Procedure, and it was pretty straightforward: cut into an Atrium, look for the ASD, and enlarge it. If you couldn’t find an ASD, make one.

Surgeons don’t perform the Blalock-Hanlon very often these days. (When I read my operative notes just a few months ago I had never even heard of the Blalock-Hanlon, much less knew that I had one!) Today the majority of ASDs are created by a balloon atrial septostomy, which is done by a catheter.

But this new procedure wouldn’t cut the skin at all. Histotripsy is “tissue liquification by ultrasonic wave” – the same technology they use when your uncle has his gallstones crushed. The suffix “-tripsy” is a Greek word that means “to massage” or “to crush.”

This was a small study of only ten dogs. Ultrasound was used to locate an appropriate point for an ASD and then the defect was created by Histotripsy. In nine out of ten cases, the shockwaves created an ASD, and later examination showed that there was “minimal damage” to surrounding cardiac tissue and no damage to the outside of the heart.There is also evidence that Histotripsy could be used for some cardiac ablations.

Much more research needs to be done before this becomes an accepted procedure, but the initial results are promising!

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4 Responses to “New way to create an ASD!”

  1. Crystal Says:

    Very interesting. Thanks for sharing!

    Noah had his ASD enlarged by balloon atrial septostomy but then it turned out not to be enough so a few days later they put in a stent. It looked like this mesh tube that was smaller in the middle then opened up on the ends. He didn’t have it long though. The next day we got the call that he was getting his new heart.

  2. Wendy Says:

    Very interesting!! Have you read the book “Walk on Water” by Michael Ruhlman? It’s a fabulous book….the author followed pediatric heart surgeons for over a year, writing about surgeries and their lives and going into the history of how some of these surgeries came to be developed – like the Norwood for example.
    Worth picking up for sure if you haven’t. I could barely put it down.
    Wendy

    • Steve Says:

      I read it several years ago, and last week when I spoke at the Regional CHD Forum in Tallahassee, an AUTOGRAPHED copy of the book was the speaker’s gift that Broken Hearts of the Big Bend gave me! I’ve already found a nice, safe place on my bookshelf for that copy so that it hopefully won’t get damaged!

  3. Wendy Says:

    WOW, that’s awesome! What a treasure! 🙂

    WEndy

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