Use of the Baylis radiofrequency trans-septal needle to create an atrial communication in hypoplastic left heart syndrome

Hypoplastic left heart syndrome with intact/highly restrictive atrial septum often requires emergent creation of an atrial communication to decompress the left atrium. Transcatheter trans-septal puncture in the setting of a thickened septum and a small left atrium can be a difficult and dangerous intervention. Trans-septal puncture using the Nykanen radiofrequency (RF) perforation wire in conjunction with a coaxial catheter and the Baylis RF generator has become the standard method in most centers. This approach can be challenging due to technical difficulties related to the RF wire and the flimsy coaxial catheter. We report two patients in whom we used a novel method of perforating the atrial septum using the RF Baylis trans-septal needle. The advantages of this technique are discussed.