Anterograde balloon dilatation in neonatal critical XXXX .

@entity1 @entity472 @entity337 @entity850
INTRODUCTION: Percutaneous valvotomy is an alternative therapy to surgery in newborns with critical @entity472 . However, the retrograde technique commonly used has significant morbidity and mortality. We decided to introduce anterograde percutaneous aortic valvotomy in newborns in a Pediatric Cardiology Unit and assess the immediate and follow-up results. MATERIAL AND METHODS: Between July and December 2000, three newborns with critical @entity472 underwent transcatheter anterograde valvotomy. All were in mechanical ventilation and dissociative anesthesia; vascular access was through puncture of the right femoral vein. An end-hole catheter was advanced, via the foramen ovale, to the left ventricle; a guide wire was placed in the ascending aorta; the end-hole catheter was then exchanged for a coronary balloon catheter and the aortic valve was predilated; afterwards, other low profile balloon catheters were advanced but the largest balloon never exceeded 95% of the aortic annulus diameter, previously measured by 2D echo and angiography. Data of the pre- and post-dilatation left ventricular pressures were registered; aortic valve function in the follow-up period was monitored by Doppler. RESULTS: Transaortic gradients decreased after the procedure in all three @entity1 ; no @entity337 was detected. No morbidity or mortality was associated with the technique. In the follow-up period, all the @entity1 remained in class I NYHA; the echocardiogram revealed a significant aortic gradient in one @entity1 with a small aortic annulus and mild @entity337 in another @entity1 . CONCLUSIONS: Anterograde percutaneous valvotomy in newborns with critical @entity850 is a useful technique and overcomes the problems associated with surgery and the retrograde technique: it should be more widely used.
