Anesthetic management of a 656-g neonate undergoing pulmonary valvotomy

We describe the successful management of a 656-g preterm infant of 29 weeks' postconceptional age undergoing closed transventricular pulmonary valvotomy. The patient had a critical pulmonary stenosis and was treated with an infusion of prostaglandin E1, which resulted in excessive pulmonary blood flow through the ductus arteriosus. The key points in anaesthetic management were maintaining an optimum balance between the systemic and pulmonary circulation and preparing for the abrupt haemodynamic change caused by valvotomy.