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Defective limb growth after retrograde balloon valvuloplasty

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This case involves an infant born prematurely at 24 weeks' gestation, with a birth weight of 560 g. After three weeks cardiac decompensation with pulmonary oedema and renal failure occurred. Severe coarctation of the aorta with a pressure gradient of 53 mm Hg was diagnosed by echocardiography. Since surgery was not an option, balloon valvuloplasty was performed after cutdown of the right femoral artery using a 3 French sheath (diameter of the sheath 1.1 mm; diameter of the femoral artery assessed by duplex sonography 0.7 mm). Balloon dilatation was performed using coronary angioplasty catheters (balloon diameter 3 mm and 4 mm). The pressure gradient was reduced to 12 mm Hg. At follow up echocardiography eight weeks after the procedure, there was no recurrence of the coarctation.

Complete thrombotic occlusion of the right femoral artery was evident early after the intervention, despite intravenous administration of heparin. Fibrinolysis was considered to be associated with an unacceptably high risk in this prematurely born infant. Although rapid collateral formation in the groin led to restoration of pedal pulses, defective limb growth became evident eight weeks after the intervention (actual size).