Intraoperative balloon valvuloplasty for critical aortic valvular stenosis in neonates

Critical aortic stenosis (AS) in the neonate represents a particularly severe form of AS where normal compensatory mechanisms are unable to maintain homeostasis, even at rest. Critical AS may be defined as aortic valve stenosis with congestive heart failure and signs of decreased systemic cardiac output.¹ When patients present in infancy with aortic valve stenosis and congestive heart failure, medical management is frequently unsuccessful. Various surgical procedures using both open and closed heart techniques have been attempted to relieve critical AS in infancy.^2-7 Percutaneous transluminal balloon valvuloplasty has been performed in patients with critical AS in infancy.⁷ This procedure is technically difficult and at times impossible. The use of balloon valvuloplasty in the operating room has been described for the treatment of AS.^8,9 The technical aspects of intraoperative balloon valvuloplasty and the range of application are still being investigated. Reported complications include severe aortic regurgitation and disruption of an aortic valve cusp. This report describes the use of intraoperative balloon valvuloplasty in 4 neonates who presented with critical AS in the first week of life.