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 di lation of severe aortic valve stenosis in neonates. Background. There is a high incidence of iliofemoral artery complications after retrogra de balloon dilation of the aortic valve in the neonate. Therefore, a n onarterial technique of catheter access to the aortic valve would be w orth exploring. Methods. Group 1 included 11 consecutive patients (med ian age 6 days, range 1 to 42; median weight 3.5 kg, range 2.16 to 4.2 5) 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 approa ch had failed. Results. The valve was successfully crossed in 9 of 11 antero grade and 13 of 15 retrograde dilations. In both groups, the pe ak 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 o f unrecognized valve leaflet perforation. Two patients in group 1 deve loped persistent, mild mitral insufficiency. Femoral artery thrombosis developed in one patient after antero grade dilation and in eight aft er retrograde dilation (p = 0.03). Conclusions. This series demonstrat es that an anterograde approach for balloon angioplasty of severe neon atal aortic valve stenosis is feasible, achieves good hemodynamic reli ef and lessens morbidity compared with retrograde arterial techniques. (C) 1997 by the American College of Cardiology.