A Rare Case of Retrograde Aortic Balloon Valvuloplasty in a Neonate with LV Dysfunction

A 25 day old male neonate presented to our institution with excessive sweating during feeds since few days after birth. On examination the neonate appeared weak with decreased feeding (Weight 2.8 kg). He was tachypneic with feeble pulses. There was no hepatomegaly. Cardiovascular examination revealed cardiomegaly, vulvar ejection click and an ejection systolic murmur of aortic stenosis. Left ventricular hypertrophy was recorded in the ECG and the chest X-ray showed cardiac enlargement. Two dimensional echocardiography revealed an enlarged hypertrophied left ventricle with reduced left ventricular function and a tricuspid aortic valve with systolic doming. A gradient of 102 mm Hg was recorded on Doppler examination.

After obtaining informed written consent for BAV the recorded baseline hemodynamic data suggested severe valvular AS with an aortic valve gradient of 108 mg Hg. We dilated the aortic valve using a 10 mm balloon (annulus size 10 mm) mounted on a 5 French catheter passed percutaneous via the right femoral artery. Theresult gradient across the aortic valve was 54 mm Hg. The procedure was uneventful except for transient ectopic during balloon dilatations. At the time of discharge the infant was feeding well without head sweats. Short term fallow up revealed favourable outcome.The optimal management for critical aortic stenosis in early infancy continues to challenge cardiologists and cardiac surgeons. Trans catheter aortic balloon valvuloplasty has become the first-line treatment for critical aortic stenosis (AS) in neonates. However, need to know more about the growth and function of left heart structures or about patterns of re-intervention on the left heart after neonatal aortic balloon valvuloplasty.  Read more.....