Overcoming critical aortic stenosis: a rare case report on successful balloon valvotomy at 16 hours of life

Abstract

Congenital aortic stenosis is a significant cardiac malformation, comprising 5% of cardiac disorders in childhood, and is more prevalent in males. The most common type is bicuspid aortic valve and the stenosis can lead to a mortality rate of 40-50% if left untreated. Initial presentations often require urgent hemodynamic, respiratory, and metabolic resuscitation. Effective management aims to maintain systemic blood flow, typically through balloon dilation or surgical valvotomy. In this case, we present a neonate born to a 39-year-old G6P5L5 mother via normal vaginal delivery, with a birth weight of 2.7 kg. Although the mother had no antenatal risk factors, an anomaly scan revealed aortic stenosis with left ventricular hypertrophy. The infant cried immediately after birth, but an ejection systolic murmur was detected in the right second and third intercostal spaces on auscultation. Postnatal echocardiography confirmed severe aortic stenosis, significant left ventricular systolic dysfunction, mild to moderate mitral regurgitation. At 16 hours of life, the neonate underwent successful percutaneous balloon aortic valvotomy via right femoral access, leading to improved hemodynamics. The infant was discharged on day 5 and is now thriving at one year of age on anti-failure medications. This case underscores the vital role of early detection and intervention in congenital heart disease. Timely management significantly improves outcomes and mitigates the risks associated with congenital aortic stenosis. The integration of prenatal screening and immediate postnatal evaluation is crucial for optimizing care in affected infants, highlighting advancements in paediatric cardiology that enhance prognoses for these conditions.