Case Report: Anaesthetic management in Balloon Coarctoplasty in a 2 Month Old Infant with Coarctation of Aorta and Dilated Cardiomyopathy

Coarctation of the aorta is a congenital narrowing of the descending aorta that can present early in infancy with heart failure and systemic hypoperfusion. We report the case of a 2-month-old, 3-kg infant diagnosed with coarctation of the aorta associated with dilated cardiomyopathy, who presented with bilateral pedal edema. Clinical evaluation revealed significant upper-lower limb blood pressure and oxygen saturation gradients with feeble femoral pulses. Echocardiography demonstrated coarctation of the aorta with bicuspid aortic valve, small patent ductus arteriosus, global left ventricular hypokinesia, and reduced systolic function. CT aortography confirmed severe narrowing of the descending thoracic aorta distal to the left subclavian artery. The child underwent balloon coarctoplasty under general anaesthesia. Serial balloon dilatation resulted in a marked reduction in the peak systolic gradient from 50 mmHg to 19 mmHg, with immediate improvement in lower limb perfusion, blood pressure, and oxygen saturation. The procedure was uneventful from an anaesthetic standpoint. This case highlights the importance of early diagnosis, meticulous anaesthetic management, and timely catheter-based intervention in infants with coarctation of the aorta complicated by ventricular dysfunction, leading to favourable immediate hemodynamic outcomes.