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Balloon atrial septostomy was performed under two-dimensional echocardiographic control in 18 consecutive neonates. Initially, a subcostal long-axis view was used to guide the catheter into the right atrium. Then, by tilting the transducer medially, a plane traversing the inferior vena caval-right atrial junction, foramen ovale, and left atrium was obtained to direct the manipulation of the catheter into the left atrium and monitor the septostomy procedure. As the catheter was always in view, catheter manipulation was easy and complications were avoided.
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