Critical pulmonary valve stenosis in the neonate: A technique to facilitate balloon dilation

Critical pulmonary valve stenosis associated with ductal dependent pulmonary blood flow is rare, accounting for a small proportion of all infants undergoing balloon dilatation.¹ Valvuloplasty in these infants may be technically difficult and at times impossible due to inability to traverse the critically stenotic valve. Previous investigators have described a gradational approach whereby balloon catheters of increasing diameter (2, 4, 6, 8 and 10 mm) are sequentially advanced and inflated across the valve relieving the obstruction.² This approach, however, is time consuming and subjects the infant to prolonged fluoroscopy exposure. We have developed a valvuloplasty technique in the neonate with critical pulmonary valve stenosis which shortens fluoroscopy time and facilitates catheter advancement across the critically stenotic valve.