Balloon Dilatation of Critical Aortic Stenosis through ECMO Cannula in a Newborn

Objectives: In neonates the groin vessels, especially the arteries, are at risk for perfusion deficits after catheterization. In low cardiac output this risk might be even increased. Therefore we modified the ECMO circuit with a valve in the arterial line and performed the balloon dilatation of the aortic valve through the ECMO cannula.

Methods: We report of a female neonate who presented with critical aortic stenosis in cardiogenic shock on day 10 after birth. The patient was primarily discharged after birth from the obstetrics department after initial uneventful adaptation after birth. A heart defect was not known prior to birth. She was seen at an external pediatric department and presented with tachypnea, prolonged capillary refill time and exhaustion during feeding. She quickly deteriorated and was intubated and ventilated. After primarily assuming a neonatal sepsis in an echocardiography a duct dependent systemic circulation was suspected and she was put on alprostadil and transferred to our hospital. On admission the baby presented with signs of severe systemic cardiovascular insufficiency with capillary refill time longer than 6s, a deteriorated blood gas analysis with a minimal pH of 6.8 and a lactate of more than 20mmol/l. On admission the patient showed a heavily impaired systolic LV function with little antegrade flow via a stenotic aortic valve and a PDA dependent systemic circulation with a hypertrophic and dilatated RV. The patient was immediately put on AV-ECMO (cannulas in right carotid artery (8F) and right jugular vein (12F).

Results: After modification of the ECMO circuit with a valve in the arterial line next to the cannula in the carotid artery we performed balloon dilatation (Tyshak balloon, 7 mm, 2 cm, 4 atm) of the aortic valve through the ECMO cannula. The ECMO needed not to be stopped nor a remarkable reduction in flow occurred during the dilatation. The intervention was successfully done without any complication. The follow up was uneventful. The patient was weaned from ECMO on day 16 after birth and discharged from hospital on day 36 after birth with a minimal aortic insufficiency and a maximum velocity of 1.5 m/s via the aortic valve. The patient is now 12 month old and did not need any further interventions so far.

Conclusion: Balloon dilatation through the cannula of an AV-ECMO in neonates is feasible and safe. It protects the groin vessels of small babies in need for a heart catheterization.

No conflict of interest has been declared by the author(s).