Echocardiographic Assessment of Cardiac Phenotype Predicts Complications and Guides Intensive Care Management Following Pulmonary Valve Balloon Dilation in Neonates With Pulmonary Atresia/Critical Pulmonary Stenosis With Intact Ventricular Septum

Abstract

Introduction

Pulmonary valve balloon dilation (PVBD) has largely replaced surgical decompression as the preferred treatment for neonates with pulmonary atresia with intact ventricular septum (PAIVS) or critical pulmonary stenosis (CPS). This study aims to evaluate whether echocardiographic morphological and functional assessment can predict early complications and guide intensive care management following PVBD in this population.

Methods

We retrospectively analyzed 27 neonates with PAIVS or CPS who underwent PVBD between 2017 and 2023. Patients were divided into Group A (tripartite right ventricle [RV], developed infundibulum) and Group B (bipartite RV, hypoplastic infundibulum). Echocardiographic, catheterization, and clinical data were reviewed and compared.

Results

Group A had higher rates of transient left ventricular systolic dysfunction (92.9% vs. 15.4%, p < 0.001) and required more ventilatory and inotropic support. Group B was more prone to infundibular spasm (76.9% vs. 21.4%, p = 0.004) and often needed beta-blockers or additional pulmonary blood flow.

Conclusion

Echocardiographic RV phenotype is associated with specific post-PVBD complications and may help guide early post-procedural management.