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Balloon dilatation of critical left heart stenoses in low birthweight infants
A Koch1, G Buheitel, S Gerling
1Hospital for Children and Adolescents, Division of Pediatric Cardiology, Friedrich-Alexander University of Erlangen-Nürnberg, Germany.
Insights
Balloon angioplasty is a feasible treatment for infants, including neonates under 1500g, with aortic valve stenosis or coarctation of the aorta. Special precautions are needed for very small infants undergoing this cardiac intervention.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Neonatal Medicine
Background:
- Congenital heart defects like aortic valve stenosis and coarctation of the aorta require timely intervention in infants.
- Minimally invasive procedures are preferred for low birthweight neonates due to associated risks.
Purpose of the Study:
- To evaluate the feasibility and outcomes of balloon angioplasty in infants with critical congenital heart disease.
- To assess the safety and efficacy of balloon dilatation in neonates and low birthweight infants.
Main Methods:
- Retrospective analysis of 5 infants (850-2400g) undergoing balloon angioplasty.
- Procedures included treatment for severe aortic valve stenosis and isthmic coarctation of the aorta.
Main Results:
- Successful relief of stenosis in all 5 patients.
- Two patients with aortic valve stenosis experienced femoral artery thrombosis, resolved with thrombolytic therapy.
- Diminished pulses persisted in the right leg for patients with coarctation.
- All patients demonstrated positive outcomes at long-term follow-up (0.28-3.32 years).
Conclusions:
- Balloon angioplasty is feasible and effective in neonates weighing less than 1500g.
- Special precautions for temperature management and improved arterial access techniques are crucial for very small infants.
Unlabelled:
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 < 1500 g. 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.