Electrosurgical energy in combination with a transseptal needle: a novel method for the creation of an atrial communication in hypoplastic left heart syndrome with intact atrial septum.

Neonates with hypoplastic left heart syndrome (HLHS) and intact atrial septum (IAS) usually present with severe acidosis and hypoxemia that necessitate immediate intervention to create an atrial septal defect (ASD). Transcatheter creation of an ASD in these patients requires transseptal puncture of a thickened atrial septum in the setting of a very small left atrium. We report on a novel method of perforating the atrial septum using radio-frequency energy in combination with a transseptal needle to facilitate transseptal puncture and subsequent stent placement in a very thick atrial septum of a newborn with HLHS/IAS and a small left atrium.