Treatment of critical pulmonary valve stenosis by balloon dilatation in the neonate

Balloon Valvuloplasty of Critical Pulmonary Valve Stenosis in a Premature Neonate

“…Subsequent oral treatment with propranolol was discontinued after 4 weeks without evidence of recurring infundibular obstruction. The success of balloon valvuloplasty in our premature patient suggests that balloon dilatation in low-birthweight infants can be performed using balloons with a diameter/annulus ratio of about 1.3, as has been suggested in normal weight neonates [3,4,5]. In accordance with Colli et al [3], we found that a markedly thickened pulmonary valve does not exclude good results using balloon dilatation in neonates [3].…”

“…Several studies have shown that balloon dilatation is a good alternative to surgical treatment of critical pulmo- Pediatric Cardiology nary stenosis in neonates [3,5,6,12]. Premature infants and infants with low birth weight and critical pulmonary valve stenosis are a therapeutic challenge, since they encounter several specific problems, including avoidance of temperature loss during the procedure, venous access, and problems related to the small anatomical size of the cardiac structures.…”

“…Premature infants and infants with low birth weight and critical pulmonary valve stenosis are a therapeutic challenge, since they encounter several specific problems, including avoidance of temperature loss during the procedure, venous access, and problems related to the small anatomical size of the cardiac structures. There are only few patients reported in the literature who underwent successful balloon dilatation of critical pulmonary valve stenosis with a body weight of less than 2.5 kg [5,7,8,12,14].…”

“…The 7-mm balloon catheter we used (Osypka, Grenzach-Whylen, Germany) proved ideal for the pulmonary valvuloplasty, since its low profile allowed it to be introduced through a 4 French sheath, thus avoiding the damage to the femoral vein that can be a major complication of balloon valvuloplasty [3,7,13]. Furthermore, due to the small diameter of the balloon catheter, a more time consuming multistep gradational approach using progressively larger balloons [3,5,11], or the application of a so-called transductal guidewire rail technique [8], were not necessary. Severe infundibular reaction that was responsible for persisting suprasystemic right ventricular pressure in one of our patients, can be treated effectively by intravenous administration of propranolol [9,12].…”

“…In many centers, pulmonary balloon valvuloplasty has become the method of choice for the treatment of infants with critical pulmonary valve stenosis [1,3,4,5]. Although the morbidity and mortality of this procedure is certainly higher in infants than in older patients with congenital pulmonary valve stenosis, the results of balloon valvuloplasty in infants compare favorably with the results of surgical valvotomy [1,2,4,6].…”