Management of critical pulmonary stenosis in the newborn

Balloon pulmonary dilatation appears to be a safe and effective technique for the emergency management of critical pulmonary stenosis in neonates.Procedural complications can be controlled with a careful technique guided by fluoroscopy and echocardiography.In the short term, a non-negligible morbi-mortality may occur during the immediate evolution due to a maladjusted VD (by functional and/or morphological failure) despite an apparent procedural success.This unfavorable evolution can be avoided by a prolonged infusion of Prostine in order to improve the pulmonary flow and in case of failure by a stenting of the ductus arteriosus or a surgical SP shunt.The medium-term evolution is burdened by an incompressible rate of restenosis, essentially valvular but also subvalvular and/or insufficient growth of the VD despite an initial procedural success.In case of restenosis, balloon redilation is always recommended even in subvalvular locations. This can promote DV growth. This strategy will allow an anatomic repair and avoid a functional repair of the one-and-a-half ventricle type.