title: Ascending aortic approach for balloon aortic valvuloplasty with concomitant bilateral pulmonary artery banding in a very low-birth-weight neonate with critical aortic stenosis and poor left ventricular function.
abstract: An 1186-g infant was born at 27 weeks' gestation. Echocardiography showed critical aortic stenosis, a dilated left ventricle (left ventricular end-diastolic diameter, 16.9 mm), and poor left ventricular function (left ventricular ejection fraction, 8.5%). Due to duct-dependent systemic circulation, the patient underwent a hybrid intervention consisting of bilateral pulmonary artery banding (PAB) and balloon aortic valvuloplasty (BAV) via the ascending aorta on day 2. A stainless steel tip and a 6-French introducer were combined to create an access device. The access device was inserted into the ascending aorta, through which balloon catheters were manipulated. On day 4, echocardiography showed a left ventricular ejection fraction of 48% and dominant antegrade blood flow in the aortic arch. The pulmonary artery bands were removed and the ductus was clipped on day 8 to establish in-line circulation. After re-balloon aortic valvuloplasty for restenosis, the patient was discharged from the hospital at 7 months of age. The clinical implications of this case are: the ascending aortic approach is feasible for BAV in low-birth-weight neonates; and bilateral PAB performed concomitantly with BAV may be efficient for neonates with critical aortic stenosis and poor left ventricular function.
authors.affiliation: Division of Cardiovascular Surgery, National Medical Center for Children and Mothers, Tokyo, Japan. kimu-mitu13@nifty.com
authors.forename: Mitsutoshi
authors.initials: M
authors.lastname: Kimura
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Misaki
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Kato
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Kaneko
mesh_terms: D001024:Aortic Valve Stenosis / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D001724:Birth Weight; D002404:Catheterization / Q000379:methods*; D003250:Constriction; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000175:diagnosis / Q000628:therapy*; D019102:Infant, Very Low Birth Weight; D008297:Male; D011651:Pulmonary Artery / Q000601:surgery*; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000175:diagnosis / Q000628:therapy*