Balloon atrial septostomy for left ventricular decompression in patients receiving extracorporeal membrane oxygenation for myocardial failure

We describe the use of balloon atrial septostomy to decompress the left ventricle in four patients receiving extracorporeal membrane oxygenation for acute intractable myocardial failure. These patients were becoming clinically worse and had evidence of left ventricular and left atrial hypertension either by direct measurement or echocardiography. Atrial decompression was accomplished by blade septostomy in one patient and by balloon atrial septostomy under echocardiographic guidance at the bedside in three patients. Three of four patients improved after balloon atrial septostomy and survived. This procedure may be helpful in selected, patients receiving extracorporeal membrane oxygenation for myocardial failure with evidence of increased left atrial pressure as a result of increased ventricular pressure.