Balloon pulmonary valvuloplasty in a premature neonate

Interventional cardiac catheterization procedures in low-birth-weight neonates are associated with specific problems including hypothermia during the procedure, difficulty in vascular access, and problems related to the small size of cardiac structures. Physical examination of a premature neonate, delivered by cesarean section at the 34th week of gestation with birth weight of 1790 g revealed a systolic murmur of 3/6 intensity. The murmur continued on the following day and cardiomegaly was observed on a chest radiogram. Echocardiographic examination revealed a patent foramen ovale with right-to-left shunt, patent ductus arteriosus, right ventricular hypertrophy, and valvular pulmonary stenosis. Balloon pulmonary valvuloplasty was performed upon detection of increased right ventricular pressure and pulmonary artery pressure gradient and development of marked tachypnea and dyspnea. Following the procedure, right ventricular pressure and pulmonary gradient decreased and the infant was discharged eight days after the procedure. Pulmonary artery pressure gradient was 56 mmHg after a month.