Happy birthday, interventional pediatric cardiology! On May 10, 1965, Dr. William Rashkind of @ChildrensPhila performed the first ever balloon atrial septostomy on a pt. It was the first successful use of a balloon catheter to palliate a congenital heart defect. #CHD #pedscards

The creation of mixing defects to palliate infants with transposition of the great arteries had been performed since 1948 when Vivien Thomas developed a closed atrial septectomy (Blalock-Hanlon) procedure that was widely adopted, but that carried a non-trivial perioperative risk.

According to H.R. Wagner, in the early 1960s, Rashkind was giving a lecture on #CHD to a group of first-year dental students. One student asked why the catheters and other gadgets Rashkind had shown couldn't be used to treat patients rather than just diagnose them.

Whether or not this was his inspiration, Rashkind set his mind to creating an intra-atrial communication using a catheter. He tried several approaches without success--a bent wire, a blade, a hemostat-like instrument--but none yielded a big enough or durable enough shunt.

The "eureka" moment came from a procedural complication. Rashkind called the vascular surgeon for a patient of his who had developed a clot in the femoral artery. As he watched the surgeon extract the clot with a Fogarty catheter, he realized the balloon might be the answer.

Rashkind first tested his procedure on six littermate puppies, passing a deflated catheter-tipped balloon through the foramen ovale, inflating the balloon, and then rapidly pulling the catheter back across the septum. The results were exactly as Rashkind had hoped.

On May 10, 1965, Rashkind performed the balloon atrial septostomy procedure on a patient for the very first time. You can see on angiography how big the inflated balloon is in relation to the heart.

In this photograph of Dr. Rashkind and Dr. John Waldhausen, the surgeon for the first six infants to undergo balloon septostomy, their very first patient is at the far right. All of these children would go on to undergo atrial switch operations.

As of 1992, she was reported to be alive and well, although she suffered a stroke in the interval between the atrial septostomy and her atrial switch operation at 3 years of age.