Balloon dilation of severe aortic stenosis in the neonate: comparison of anterograde and retrograde catheter approaches.

OBJECTIVES

We sought to compare anterograde and retrograde balloon dilation of severe aortic valve stenosis in neonates.

BACKGROUND

There is a high incidence of iliofemoral artery complications after retrograde balloon dilation of the aortic valve in the neonate. Therefore, a nonarterial technique of catheter access to the aortic valve would be worth exploring.

METHODS

Group 1 included 11 consecutive patients (median age 6 days, range 1 to 42; median weight 3.5 kg, range 2.16 to 4.25) undergoing attempted anterograde dilation through a femoral venous approach. Group 2 included 15 patients (median age 3 days, range 1 to 35; median weight 3.4 kg, range 2.5 to 4.4 kg) who underwent attempted retrograde dilation, including 2 in whom attempted anterograde approach had failed.

RESULTS

The valve was successfully crossed in 9 of 11 anterograde and 13 of 15 retrograde dilations. In both groups, the peak gradient across the valve decreased significantly (both p = 0.001). On echocardiography, the jet width of the aortic incompetence/ annulus diameter ratio was 0.16 +/- 0.08 (mean +/- SD) after anterograde and 0.51 +/- 0.24 after retrograde dilation (p = 0.03), possibly because of unrecognized valve leaflet perforation. Two patients in group 1 developed persistent, mild mitral insufficiency. Femoral artery thrombosis developed in one patient after anterograde dilation and in eight after retrograde dilation (p = 0.03).

CONCLUSIONS

This series demonstrates that an anterograde approach for balloon angioplasty of severe neonatal aortic valve stenosis is feasible, achieves good hemodynamic relief and lessens morbidity compared with retrograde arterial techniques.