Balloon dilatation of critical left heart stenoses in low birthweight infants

Abstract

We describe the results of balloon angioplasty in 5 infants with body weights of 850‐2400 g. Three patients with severe aortic valve stenosis and two patients with isthmic coarctation of the aorta experienced relief of stenosis. Two patients with aortic valve stenosis developed thrombosis of the femoral artery; however, complete resolution of the compromised pulse occurred following thrombolytic therapy. In both patients with isthmic coarctation, pulses on the right leg remained diminished. All patients are doing well 0.28 to 3.32 y after the procedure; none has required additional therapy. Our results in a limited number of consecutive low birthweight infants show that balloon dilatation is feasible and can be performed successfully even in neonates with body weights <1500g. According to our experience, balloon dilatation in infants with body weights >2000 g does not differ significantly from standard procedures. In very small infants, however, balloon angioplasty requires special precautions to avoid temperature loss. Arterial access is the major problem in small children, and requires further improvement. Conclusion: Balloon dilatation is feasible even in neonates < 1500 g. However, special precautions to avoid temperature loss are required and arterial access is the major problem.

Interventional fetal balloon valvuloplasty for congenital heart disease—current shortcomings and possible perspectives

“…During the last two decades, neonatal balloon valvuloplasty of critical aortic and pulmonary stenosis has become the treatment of choice for the majority of these patients [53][54][55][56]. In children with critical pulmonary stenosis, mortality of the neonatal intervention is well below 5% [56].…”

“…In children with critical pulmonary stenosis, mortality of the neonatal intervention is well below 5% [56]. Successful balloon valvuloplasty of critical pulmonary and aortic stenosis has been performed in premature infants with birth weights well below 2000 g [53,54,56]. Therefore, if fetal echocardiography provides clear evidence of deteriorating hemodynamics, premature delivery by cesarean section can be an option in the 3rd trimester to allow neonatal interventional treatment of critical stenoses with impending cardiac decompensation.…”

“…Postnatal balloon aortic valvuloplasty is a widely accepted treatment modality and represents the procedure of choice in many units for children of all ages with congenital valvular aortic stenosis [53,[56][57][58][59]. The growing fetus who would subsequently require a postnatal balloon aortic valvuloplasty presents a challenge to the pediatric cardiologist or cardiac surgeon to provide an early treatment that ideally will allow compensatory growth even before birth.…”

“…The influence of factors, such as optimized postnatal operative technique according to anatomic subtypes, on mortality and postinterventional course may outweigh lesser benefits achieved by prenatal relief of outflow obstruction. For example, postnatal studies on aortic valve repair and replacement after balloon valvuloplasty for congenital aortic stenosis in children have shown anatomic variables to be determinants of interventional results [53,[57][58][59]. Better prenatal predictive parameters will be needed to allow prenatal interventions to be properly targeted.…”

Primary coronary stent implantation is a feasible bridging therapy to surgery in very low birth weight infants with critical aortic coarctation

“…In very low birth weight (VLBW) infants (≤1500 g) earlier treatment is sometimes warranted due to systemic hypoperfusion, pulmonary hyperperfusion and/or hypertension. Options for treatment include surgery [2][3][4][5], percutaneous balloon dilatation [6][7][8][9][10][11] and percutaneous stent implantation [12,13]. We reviewed our results of primary stent implantation as bridging therapy to surgery in VLBW infants with a critical CoA in whom PGE had to be discontinued.…”