Introduction: Critical neonatal aortic stenosis remains a difficult condition to manage. Small left ventricular size, poor left ventricular function and the presence of endocardial fibro-elastosis are all associated with higher morbidity and mortality.
Methods: A 4,2kg newborn of mother with poorly controlled insulin-dependant diabetes mellitus presented with poor circulation and critical aortic stenosis. Initial 6 mm balloon dilatation was successful, but the infant tolerated biventricular circulation poorly: small left ventricular volume and significant pulmonary hypertension; a single ventricle hybrid approach was decided upon. This strategy would buy some time and allow the left ventricle potentially to grow.
Report: At day 25 : Rashkind and duct stented 9/19 mm, followed by 4mm Goretex bands on branch pulmonary arteries. At 8 months, test occlusion of the ductus and interatrial septum indicated that biventricular repair was possible. The bands were progressively dilated to 8mm and the ductus closed with a 4/6 Amplatzer ductal occluder and 8mm Amplatzer vascular occlusion device. At 3.2years he is doing well with a biventricular circulation and small residual interatrial shunt.
Conclusion: hybrid procedure may be considered in neonates with borderline left heart as a bridge to possible biventricular repair. Biventricular repair may be achieved by percutaneous intervention avoiding further surgery.