Endovascular atrial septostomy

Summary

The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on endovascular atrial septostomy.

Description

The main indication for this procedure is transposition of the great arteries, an uncommon congenital cardiac anomaly in which the aorta arises from the right ventricle and the pulmonary trunk arises from the left ventricle. Less commonly, septostomy is carried out in children with other cyanotic congenital abnormalities.

Endovascular atrial septostomy is a procedure that is used to enlarge the foramen ovale. A catheter is passed through a large vein, usually in the groin, into the right atrium and through the foramen ovale to the left atrium. A balloon at the end of the catheter is inflated and pulled back into the right atrium, so enlarging the foramen ovale. Static balloon atrial septostomy is a procedure that is used to enlarge an inter-atrial communication when simple balloon septostomy is unsuccessful or contraindicated. It is usually used in older children or adults with a thick septum in whom there is no atrial communication. The septum is cut using a catheter with a blade at its end. The balloon is then used to enlarge the opening in the septum. The procedure aims to prolong survival until definitive surgery can be performed.

Without a treatment to make a connection between the right and left atria, most babies would not survive. The only babies likely to survive for even a few weeks without septostomy are those with a congenital ventricular septal defect. There is no reliable alternative to septostomy procedures in neonates. Definitive surgery is usually done several months after septostomy.

OPCS code:

K16.1 Percutaneous transluminal balloon atrial septostomy 

Y53.- Approach to organ under image control

or

K16.2 Percutaneous transluminal atrial septostomy NEC

Y53.- Approach to organ under image control 

Note: Codes within category Y53.- are used as secondary codes to classify interventions that are percutaneous and require some form of image control: if the method of image control is unspecified, Y53.9 Unspecified approach to organ under image control is assigned.

_{The NHS Classifications Service of NHS Connecting for Health is the central definitive source for clinical coding guidance and determines the coding standards associated with the classifications (OPCS-4 and ICD-10) to be used across the NHS.   The NHS Classifications Service and NICE work collaboratively to ensure the most appropriate classification codes are provided.  www.connectingforhealth.co.uk/clinicalcoding}

Details

Contact details:

Links:

	IPG86 Endovascular atrial septostomy: guidance	25 August 2004
	IPG86 Endovascular atrial septostomy: understanding NICE guidance	25 August 2004
	IPG86 Septostomi atrïaidd endofasgwlaidd: deall canllawiau NICE	30 January 2009
	IPG86 Endovascular atrial septostomy: distribution list	25 August 2004
	Interventional procedure consultation document - balloon or blade atrial septostomy in neonates	27 January 2004
	Overview of endovascular atrial septostomy	27 January 2004