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Updated: Nov 5, 2025
Hemodynamic Precision in the Neonatal Intensive Care Unit using Targeted Neonatal Echocardiography
Published on: January 27, 2023
Percutaneous coarctation dilatation under transthoracic echocardiography guidance solely without fluoroscopy in
Samir Atmani1, Said Belmkaddem2, Moustapha Elkouach1
1Medico-chirurgical Pediatric Cardiology Unit, Pediatric's department, University Hospital Center Hassan II Fez Morocco, Faculty of Medicine of Fez-morocco, University Med Benabdellah.
Insights
Transthoracic echocardiography (TTE) safely and effectively guided aortic coarctation dilatation in neonates, offering a sole guidance tool. This approach showed excellent results without complications, suggesting wider applications in neonatal intensive care.
Area of Science:
- Neonatal Cardiology
- Medical Imaging
- Interventional Echocardiography
Background:
- Neonatal coarctation requires urgent diagnosis and treatment, with surgery as the primary option.
- Balloon angioplasty is an alternative for complex cases with cardiogenic shock.
- Fluoroscopy typically guides coarctation dilatation procedures.
Observation:
- A case study details successful neonatal coarctation dilatation guided solely by transthoracic echocardiography (TTE).
- The procedure was performed at the bedside in the neonatal intensive care unit.
- High-quality TTE images were obtained using supra-sternal and lateral views.
Findings:
- TTE provided accurate diagnosis and description of the coarctation.
- The dilatation procedure took 40 minutes using TayShak balloons and a guided wire.
- Complete relief of coarctation was confirmed by TTE with no observed complications.
- Third-month follow-up showed excellent results, avoiding surgery or restenosis.
Implications:
- TTE is a safe and efficient sole guidance tool for neonatal coarctation dilatation.
- This echocardiography-guided approach is particularly beneficial for neonates with severe cardiac failure.
- The findings encourage exploration of TTE for other neonatal intensive care interventions.
Introduction:
Neonatal coarctation has to be diagnosed and treated urgently. Actually, the surgical treatment is the main option. The coarctation dilatation is usually achieved under fluoroscopy guidance whenever indicated. Balloon angioplasty could be an alternative approach or transient measure in difficult cases with cardiogenic shock or severe cardiac insufficiency.In the reported case, we prove and discuss the major role of transthoracic echocardiography, which is used solely to guide the coarctation dilatation in neonate environment.
Objective:
The reported case aims to assess the safety and the efficiency of two-dimensional TEE to guide the dilatation of aortic coarctation in neonate.
Case Presentation:
We describe successful dilatation of neonatal coarctation done exclusively using echocardiography in neonatal ICU at the bed. The procedure duration was 40 minutes (from the puncture to sheath removal). The coarctation was diagnosed easily and well described using TTE with good image quality obtained from supra-sternal plane and upper and left lateral view. TayShak balloon measuring 6 and 8 mm were used with a 0.018 French guided exchange wire.Complete relief of the coarctation was checked by TTE without recording any complication. The follow-up in the third month (the submission time of this manuscript) showed very good results without requiring any surgical intervention or additional restenosis.
Conclusion:
Our initial experience confirmed the safety and efficiency of coarctation dilatation using TTE as the only guidance tool at the bed in neonatal stage, especially in a case presenting severe metabolic and cardiac failure. This report suggests and encourages other potential applications in neonatology intensive care.
