Cardiac Interventions in Neonates: State of the Art

Percutaneous cardiac interventions in neonates and young infants have fundamentally altered the management paradigm of critical congenital heart disease, offering minimally invasive alternatives to surgery as definitive therapies or as bridges to later repair. Advances in catheter technology, device miniaturization, and imaging have enabled increasingly complex interventions to be performed safely in this highly vulnerable population. This review provides a comprehensive overview of commonly performed neonatal cardiac interventions, including balloon atrial septostomy, balloon dilatation of the aortic and pulmonary valves, ductal stenting, transcatheter patent ductus arteriosus closure in preterm infants, coarctation interventions, pulmonary valve perforation, right ventricular outflow tract stenting, pulmonary vein interventions, and emerging techniques such as percutaneous pulmonary artery banding. For each intervention, the authors outline indications, technical considerations, procedural outcomes, and limitations, with emphasis on neonatal-specific anatomical and physiological challenges. Neonatal cardiac interventions are inherently unforgiving, mandating meticulous patient selection and a structured multidisciplinary heart team approach to ensure ethical, evidence-based decision-making. The review also addresses unique challenges relevant to low- and middle-income settings, particularly India, including disparities in access to specialized care, affordability, reliance on off-label device use, and the critical role of fetal diagnosis. In conclusion, neonatal transcatheter interventions continue to expand in scope and efficacy, driven by technological innovation and collaborative care models. Addressing systemic barriers and strengthening fetal and neonatal cardiac services are essential to optimizing outcomes and ensuring equitable access to these life-saving therapies in resource-limited settings.