DOI: https://doi.org/10.14710/jai.v0i0.72347

Successful of High Risk Pulseless-Balloon Aortic Valvuloplasty Procedure in Uncorrected Pulmonary Atresia with Severe Congenital Aortic Stenosis and Low Left Ventricular Function

1Doctoral Study Program of Medical and Health Science, Universitas Diponegoro, Semarang, Indonesia, Indonesia

2Department of Cardiology, Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia, Indonesia

3Department of Surgery, Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia, Indonesia

4 Department of Anesthesiology and Intensive Care, Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia, Indonesia

5 Harapan Kita National Heart Center, Jakarta, Indonesia, Indonesia

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Received: 10 Apr 2025; Revised: 19 May 2025; Accepted: 26 Jun 2025; Available online: 7 Jul 2025.
Open Access Copyright 2021 JAI (Jurnal Anestesiologi Indonesia)
Creative Commons License This work is licensed under a Creative Commons Attribution 4.0 International License.

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Abstract

Background: Pulmonary atresia with ventricular septal defect (PA-VSD) and severe bicuspid aortic stenosis (AS) is an uncommon condition that presents significant surgical challenges. The dual obstruction leads to chronic pressure overload, resulting in ventricular hypertrophy and decreased systolic function. A low left ventricular ejection fraction (LVEF) increases the risk of mortality during surgical interventions. Percutaneous balloon aortic valvuloplasty (BAV) poses additional risks due to the intentional induction of pulselessness during balloon inflation. This case report aims to detail the perioperative management strategies employed during BAV in a patient with PA-VSD, severe AS, and low LVEF.

Case: We present a 19-year-old female patient weighing 45 kg, who presented with shortness of breath and fatigue. Her oxygen saturation was measured at 90% across all extremities. Electrocardiogram findings indicated sinus rhythm with biventricular hypertrophy and incomplete left bundle branch block. Chest X-ray revealed cardiomegaly and pulmonary artery dilation, while echocardiography confirmed PA-VSD, severe AS with a mean pressure gradient (mPG) of 55 mmHg, and an LVEF of 41.3%. A percutaneous pulseless-BAV was performed using a Tyshak balloon via an antegrade transvenous femoral approach under fluoroscopy and transesophageal echocardiography guidance.

Discussion: Anesthesia management focused on gradual medication titration, minimizing patient movement during the procedure, and ensuring comfort due to TEE probe insertion. A temporary pacemaker was placed in the right ventricle apex for pacing at 220 beats per minute until cardiac arrest occurred post-balloon inflation; defibrillation successfully restored spontaneous circulation.

Conclusion: This case illustrates that percutaneous BAV in uncorrected PA-VSD with severe AS and low LVEF is feasible despite its inherent risks when conducted by a skilled team utilizing careful judgment throughout the procedure.

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Keywords: Cardiovascular anesthesia; congenital heart disease; balloon aortic valvuloplasty; pulmonary atresia; aortic stenosis

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Article Info
Section: Case Reports
Language : EN
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  1. Liang L, Wang Y, Zhang Y. Prenatal Diagnosis of Pulmonary Atresia With Ventricular Septal Defect and an Aberrant Ductus Arteriosus in a Dextrocardia by Two- and Three-Dimensional Echocardiography: A Case Report. Front Med [Internet]. 2022;9:904662. Available from: 10.3389/fmed.2022.904662
  2. Moradian M. Pulmonary Atresia with VSD (PA-VSD) or Tetralogy of Fallot and Pulmonary Valve Atresia (TF-PA) BT - Atlas of Echocardiography in Pediatrics and Congenital Heart Diseases. In: Moradian M, Alizadehasl A, editors. Berlin, Heidelberg: Springer Berlin Heidelberg; 2021. p. 85–7. Available from: https://doi.org/10.1007/978-3-662-62341-1_27
  3. Shakya S, Rajashekar P, Gupta SK. Sequential Segmental Approach to Congenital Heart Disease. J Indian Acad Echocardiogr Cardiovasc Imaging [Internet]. 2020;4(3). Available from: https://journals.lww.com/jiae/fulltext/2020/04030/sequential_segmental_approach_to_congenital_heart.5.aspx
  4. Zhang ZJ, Zhang MK, Xue H, Fan LX. Ascending aorta dilatation for pulmonary atresia with ventricular septal defect: a report of three adult cases. J Cardiothorac Surg [Internet]. 2025 Jan;20(1):64. Available from: 10.1186/s13019-024-03293-7
  5. Xie Y, Wang S, Zhao G, Li M, Zhang F, Ouyang W, et al. Percutaneous aortic balloon valvuloplasty under echocardiographic guidance solely. J Thorac Dis [Internet]. 2020 Mar;12(3):477–83. Available from: 10.21037/jtd.2020.01.16
  6. Olasińska-Wiśniewska A, Trojnarska O, Grygier M, Lesiak M, Grajek S. Percutaneous balloon aortic valvuloplasty in different age groups. Postep w Kardiol interwencyjnej = Adv Interv Cardiol [Internet]. 2013;9(1):61–7. Available from: 10.5114/pwki.2013.34029
  7. Awasthy N, Radhakrishnan S, Iyer KS, Sharma R. Reversible ventricular dysfunction in cyanotic heart disease. Indian Heart J [Internet]. 2014;66(6):704–6. Available from: https://www.sciencedirect.com/science/article/pii/S0019483214002570
  8. Ito S, Miranda WR, Nkomo VT, Connolly HM, Pislaru S V, Greason KL, et al. Reduced Left Ventricular Ejection Fraction in Patients With Aortic Stenosis. J Am Coll Cardiol [Internet]. 2018;71(12):1313–21. Available from: https://www.sciencedirect.com/science/article/pii/S073510971830322X
  9. Charafeddine FA, Houssein HB, Kibbi NB, El-Rassi IM, Tabbakh AM, Abutaqa MS, et al. Balloon Valvuloplasty for Congenital Aortic Stenosis: Experience at a Tertiary Center in a Developing Country. J Interv Cardiol [Internet]. 2021;2021:6681693. Available from: 10.1155/2021/6681693
  10. Keeble TR, Khokhar A, Akhtar MM, Mathur A, Weerackody R, Kennon S. Percutaneous balloon aortic valvuloplasty in the era of transcatheter aortic valve implantation: a narrative review. Open Hear. 2016;3(2):e000421
  11. Fleisher LA, Fleischmann KE, Auerbach AD, Barnason SA, Beckman JA, Bozkurt B, et al. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation [Internet]. 2014 Dec;130(24):2215–45. Available from: 10.1161/CIR.0000000000000105
  12. González LF, Mata RB, Meabe JA, García ML, Miranda JMG. Percutaneous balloon valvuloplasty validity for congenital aortic stenosis. Experience since the beginning of the tequnique. An Pediatría (English Ed [Internet]. 2022;96(3):265–7. Available from: https://www.sciencedirect.com/science/article/pii/S2341287922000266
  13. Lee G, Chikwe J, Milojevic M, Wijeysundera HC, Biondi-Zoccai G, Flather M, et al. ESC/EACTS vs. ACC/AHA guidelines for the management of severe aortic stenosis. Eur Heart J [Internet]. 2023 Mar 7;44(10):796–812. Available from: https://doi.org/10.1093/eurheartj/ehac803
  14. Thourani VH, O’Brien SM, Kelly JJ, Cohen DJ, Peterson ED, Mack MJ, et al. Development and Application of a Risk Prediction Model for In-Hospital Stroke After Transcatheter Aortic Valve Replacement: A Report From The Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry. Ann Thorac Surg. 2019 Apr;107(4):1097–103
  15. Kiani S, Kamioka N, Black GB, Lu MLR, Lisko JC, Rao B, et al. Development of a Risk Score to Predict New Pacemaker Implantation After Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv. 2019 Nov;12(21):2133–42

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