Background <p>Critical aortic valve stenosis in neonates and infants is a life-threatening congenital heart disease characterized by severe left ventricular outflow tract obstruction and compromised systemic perfusion. Balloon aortic valvuloplasty (BAV) has become an established initial treatment option; however, data on early outcomes in this vulnerable population remain relatively limited.</p> Methods <p>This retrospective single-center study included 30 neonates and infants (≤ 12 months) with critical aortic valve stenosis who underwent balloon aortic valvuloplasty between 2016 and 2024. Clinical, echocardiographic, and hemodynamic parameters were analyzed before and after the procedure. Early procedural success, complications, and short-term outcomes were assessed.</p> Results <p>Balloon aortic valvuloplasty resulted in a significant immediate reduction in transaortic pressure gradients (<i>p</i> &lt; 0.05), indicating effective relief of left ventricular outflow tract obstruction. Left ventricular systolic function improved or remained stable in the majority of patients. New-onset or increased aortic regurgitation occurred in some cases, predominantly mild to moderate in severity, while severe regurgitation was uncommon. Early mortality was low, and most patients demonstrated favorable early clinical stabilization. Some patients required reintervention or surgical referral because of residual stenosis or progressive aortic regurgitation.</p> Conclusions <p>Balloon aortic valvuloplasty is a safe and effective first-line treatment for critical aortic valve stenosis in neonates and infants, providing rapid hemodynamic improvement with acceptable early outcomes. The procedure represents an important therapeutic strategy in the initial management of this high-risk pediatric population.</p>