Anterograde balloon dilatation in neonatal critical aortic stenosis.
BACKGROUND
Percutaneous valvotomy is an alternative therapy to surgery in newborns with critical aortic stenosis. However, the retrograde technique commonly used has significant morbidity and mortality. We decided to introduce anterograde percutaneous aortic valvotomy in newborns in a Pediatric Cardiology Unit and assess the immediate and follow-up results.


METHODS
Between July and December 2000, three newborns with critical aortic stenosis underwent transcatheter anterograde valvotomy. All were in mechanical ventilation and dissociative anesthesia; vascular access was through puncture of the right femoral vein. An end-hole catheter was advanced, via the foramen ovale, to the left ventricle; a guide wire was placed in the ascending aorta; the end-hole catheter was then exchanged for a coronary balloon catheter and the aortic valve was predilated; afterwards, other low profile balloon catheters were advanced but the largest balloon never exceeded 95% of the aortic annulus diameter, previously measured by 2D echo and angiography. Data of the pre- and post-dilatation left ventricular pressures were registered; aortic valve function in the follow-up period was monitored by Doppler.


RESULTS
Transaortic gradients decreased after the procedure in all three patients; no aortic regurgitation was detected. No morbidity or mortality was associated with the technique. In the follow-up period, all the patients remained in class I NYHA; the echocardiogram revealed a significant aortic gradient in one patient with a small aortic annulus and mild aortic regurgitation in another patient.


CONCLUSIONS
Anterograde percutaneous valvotomy in newborns with critical stenosis is a useful technique and overcomes the problems associated with surgery and the retrograde technique: it should be more widely used.
Baptista
Maria João
MJ
Serviço de Cardiologia Pediátrica, Laboratório de Hemodinâmica, Hospital S. João, Porto. mjb@med.up.pt
da Silva
Eduardo Dias
ED
Garcia
Mota
M
Vieira
António
A
Moreira
Jorge
J
D001024:Aortic Valve Stenosis / Q000628:therapy*; D002404:Catheterization / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male