Anesthetic management of transcatheter balloon aortic valvuloplasty for neonates and infants with congenital aortic stenosis

Abstract

　Recently, transcatheter balloon aortic valvuloplasty (BVP) was performed in pediatric patients with congenital aortic stenosis (AS). We reported on cases in which neonates and infants were under general anesthesia. We will discuss three cases; Case 1: One-month-old baby; echocardiography demonstrated a transvalvular pressure gradient (PG) of 63 mmHg and left ventricular (LV) hypertrophy. Case 2: Four-dayold baby; PG of 90 mmHg with LV endocardial fibroelastosis. Case 3: Two-day-old baby; PG of 100 mmHg and a diagnosis of critical AS. BVP was performed in each of these cases. Choosing drugs with few hemodynamic effects and careful fluid management, including blood transfusions in some cases, is important. Furthermore, appropriate inotropic agents were administered for the case with severely damaged LV function. Hemodynamic changes, particularly coronary flow, LV function, and aortic insufficiency (regurgitation), during and after the procedure must be understood to minimize afterload and tachycardia.