Interventional treatment of critical coarctation of the aorta in an extremely low birth weight preterm neonate

Abstract

The authors describe successful balloon angioplasty of aortic coarctation in a preterm neonate weighing 670 grams. The intervention was performed in an open incubator to ensure stable temperature comfort and to minimise the risk of hypothermia during the procedure of obtaining surgical vessel access, performing balloon angioplasty, and closure of the wound.

Primary coronary stent implantation is a feasible bridging therapy to surgery in very low birth weight infants with critical aortic coarctation

“…Although these studies demonstrated the feasibility of surgical correction, the reported rates of reintervention (34%) and mortality (18%) were very high [2][3][4][5] (Online Supplement Table 2). Percutaneous balloon dilatation can be considered as an alternative to surgery and has been described in 11 VLBW neonates at a median age of 14 days (2-34) and weight of 850 g (460 to 1500) [6][7][8][9][10][11] (Online Supplement Table 3). However, recoarctation does occur in up to 50% of infants treated with balloon dilatation before 6 months of age [14,15].…”

“…In very low birth weight (VLBW) infants (≤1500 g) earlier treatment is sometimes warranted due to systemic hypoperfusion, pulmonary hyperperfusion and/or hypertension. Options for treatment include surgery [2][3][4][5], percutaneous balloon dilatation [6][7][8][9][10][11] and percutaneous stent implantation [12,13]. We reviewed our results of primary stent implantation as bridging therapy to surgery in VLBW infants with a critical CoA in whom PGE had to be discontinued.…”

A successful balloon angioplasty procedure in a 1050 gram premature infant with coarctation of the aorta

“…In addition, occasional cases of secondary hypertension and intracranial bleeding related to hypertension have also been reported. [1][2][3] Although performing balloon angioplasty for the recurrence of coarctation following surgical repair is a generally accepted procedure, using it for native coarctation in newborns is controversial due to the potential complications and high rate of restenosis. [1][2][3] Factors such as developments in newborn care and the availability of echocardiography may lead to the early recognition of severe coarctation before the appearance of clinical symptoms.…”

“…Surgical repair is the primary treatment for native coarctation of the aorta in newborns and infants. [1] Although experience in the use of balloon angiography for the treatment of this condition has gradually increased since it was first introduced in 1982, high rates of restenosis and complications such as an increased risk of aneurysm formation and damage to the peripheral artery involved in the procedure have been the main reasons that have prevented this procedure from becoming the treatment of choice. [2] However, balloon angioplasty has been performed as a palliative treatment in certain centers due to the high rates of mortality and morbidity associated with surgery in newborns presenting with the clinical manifestations of cardiogenic shock.…”

Transfemoral balloon angioplasty of severe coarctation of aorta in 1200 g newborn

“…Balloon angioplasty procedure in the treatment of native coarctation of the newborn is controversial due to high rates of restenosis[1] and complications such as increased risk of aneurysm formation and damage to the peripheral artery involved in the intervention. [23] We believe that in such small and sick subset of babies, balloon angioplasty is a very good palliative procedure because doing surgery in these babies is having high rates of complications.…”