First successful neonatal percutaneous cardiac intervention done in Maa Kauvery & Heart city, Trichy

Suganya Periyanayagi1, S. J. Soniya Mercy Anbu2, Ruby Ravichandran3

1NICU Supervisor, Maa Kauvery, Trichy, Tamil Nadu

2Assistant Nursing Superintend, Maa Kauvery, Trichy, Tamil Nadu

3Deputy Nursing Superintend, Maa Kauvery, Trichy, Tamil Nadu

Introduction

Pulmonary stenosis is a heart condition where the pulmonary valve which controls blood flow from the heart to the lungs, becomes narrowed, stiff or doesn’t open fully, obstructing blood flow and making the right side of the heart work harder.

38 weeks + 5 days old term neonate born by LSCS was admitted for management of suspected critical congenital cardiac disorder. Upon admission, neonate had a loud 4/6 pan systolic murmur and a single S2 heart sound, Downe score 3/10. Neonate was started on nasal oxygen, IV fluids, IV antibiotics, and other supportive measures. CPAP was connected as Spo2 remains low.

Clinical findings

ActivityGood
CryNormal
ColourAcrocyanosis was present
PerfusionPeripheries dusky

Vitals signs

HR136 b/min
RR42/min
SPO297% with CPAP 90-92% before support

Systemic Examination

CVSThere was a loud 4/6 pan systolic murmur and a single S2 heart sound
RSBilateral air entry was equal
P/ASoft
CNSAF open & level
Newborn ReflexesFair
Other Significant FindingsNil
Bone, Joint cavity & soft tissueNormal

ECHO Findings

ECHO revealed critical pulmonary stenosis and a dysfunctional hypertrophied right ventricle with suprasystemic RV pressure. Prostaglandin E1 infusion was started and saturation improved.

Diagnosis

Critical valvular pulmonary stenosis

Small PDA Left to Right Shunt

Procedure Done: Balloon pulmonary valvuloplasty.

Management

Balloon pulmonary valvuloplasty (BPV) was done at 46 hours of life. It’s a minimally invasive procedure to treat a narrowed pulmonary valve (stenosis) by inserting a catheter with a balloon guiding it to the valve and inflating the balloon to stretch open the valve leaflets improving blood flow from the heart to the lungs without open heart surgery.

Post Procedure

Post-procedure, the PS gradient was reduced to 25 mmHg with good antegrade outflow. SpO2 improved to 96%, and PGE1 infusion was tapered and stopped. CPAP was gradually weaned off. Infant was extubated within 12 hr and was discharged in 4 days. On follow up at 4 weeks, he was growing well, had residual mild pulmonary stenosis and saturation was normal. Video clip added shows glimpse of the case and procedure.

Repeat ECHO

Repeat ECHO showed hypertrophied RV with improved RV function. IAS: 3 mm PFO with left-to-right shunt. Moderate TR, RVSP 35 + RAP. Pulmonary valve thick, bicuspid with good antegrade flow. RVOT gradient due to residual valvular PS – 25 mmHg, mild PR. S/p BPV for critical pulmonary stenosis – mild RVOT with good biventricular function.

Nutrition

Minimal OGT feeds were started and graded up slowly to full oral feeds. Feeding and lactation counseling were given to the care givers. DBF was established well before discharge.

Nursing care

  • Vital Sign Monitoring:Frequent checking of HR, BP, and Respiration.
  • Cluster care: Vital signs monitoring, suctioning, Diaper change, position changing was followed meticulously, Infant tube feeding and medications were administered in same time.
  • In view of prevention of Peripheral line associated blood stream infection followed the bundle care of hand hygiene, Aseptic technique, review and early removal.
  • Followed the VAP care bundle of hand hygiene, head end elevation, weaning from sedation and early extubation for prevention of ventilator associated pneumonia.
  • Insertion Site Care:Checked for bleeding, swelling, hematoma, and distal circulation/sensation (pulses).
  • Positioning & Activity:Maintained flat bed rest (2-6+ hrs) without bending legs to prevent bleeding
  • Pain Management:Administered pain relief for insertion site soreness or discomfort from immobility.
  • Fluid Intake:Encouraged fluids to flush contrast dye, leading to frequent urination.
  • Cardiac Monitoring:done

Condition at discharge

HR148/min, S1 heard, 3/6 systolic murmur was present over precordium, S2 was split and P2 was loud.
RR48/min
SPO2In room air
Right upper limb98%
Left upper limb97%
Right lower limb98%
Left lower limb96%
Activitygood

Discharge Health Education

  • Educated the parents to give prescribed medications on time and regularly
  • Wound care and follow-up appointments.
  • Echo may be needed as per cardiologist advice
  • Emergency Signs:adviced to bring the baby to emergency services in case of any shortness of breath, swelling and bleeding around the operated site.

 Conclusion

Balloon pulmonary valvuloplasty is a safe, effective, and minimally invasive procedure for the treatment of valvular pulmonary stenosis, especially in neonates. It has become the treatment of choice due to its high success rate, immediate reduction in right ventricular outflow obstruction, and avoidance of open-heart surgery. The procedure significantly improves hemodynamics, relieves symptoms, and promotes normal growth and development in newborns. Complications are infrequent and usually mild, with pulmonary regurgitation being the most common long-term concern. Overall, balloon pulmonary valvuloplasty offers excellent short- and long-term outcomes when performed in appropriately selected patients, making it a cornerstone in the management of pulmonary valve stenosis.

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