Carotid artery approach for balloon dilation of aortic valve stenosis in the neonate: a preliminary report

Department of Pediatrics, University of Pittsburgh School of Medicine, Pennsylvania.

Balloon valvuloplasty in neonates with severe aortic valve stenosis is limited by difficulties in catheter manipulation around the arch and across the valve and by the risk of femoral artery complications. A right common carotid artery cutdown was utilized for balloon aortic valvuloplasty in five neonates 1 to 20 days of age, weighing 3.1 to 3.9 kg. Standard balloon valvuloplasty was performed through a 6F sheath inserted in the right carotid artery. The arteriotomy was repaired at the end of the procedure. Mean left ventricular systolic pressure was reduced from 142 to 97 mm Hg, with a decrease in mean peak systolic pressure gradient from 76 to 33 mm Hg. Only one patient developed mild aortic regurgitation. One patient with a hypoplastic left ventricle died, and one patient required open valvotomy. All four survivors have a normal carotid pulse and no neurologic sequelae. Two of these patients required repeat balloon dilation to treat residual aortic valve stenosis at 8 and 10 months of age, respectively. Balloon valvuloplasty using a carotid artery approach is feasible and was safe in five neonates with severe aortic valve stenosis.

This article has been cited by other articles:

				T. F. Feltes, E. Bacha, R. H. Beekman III, J. P. Cheatham, J. A. Feinstein, A. S. Gomes, Z. M. Hijazi, F. F. Ing, M. de Moor, W. R. Morrow, et al. Indications for Cardiac Catheterization and Intervention in Pediatric Cardiac Disease: A Scientific Statement From the American Heart Association Circulation, June 7, 2011; 123(22): 2607 - 2652. [Full Text] [PDF]

				G. K. Lofland, B. W. McCrindle, W. G. Williams, E. H. Blackstone, C. I. Tchervenkov, R. Sittiwangkul, and R. A. Jonas Critical aortic stenosis in the neonate: A multi-institutional study of management, outcomes, and risk factors J. Thorac. Cardiovasc. Surg., January 1, 2001; 121(1): 0010 - 27. [Abstract] [Full Text] [PDF]

				R. S. Mosca, M. D. Iannettoni, S. M. Schwartz, A. Ludomirsky, R. H. Beekman III, T. Lloyd, and E. L. Bove Critical aortic stenosis in the neonateA comparison of balloon valvuloplasty and transventricular dilation J. Thorac. Cardiovasc. Surg., January 1, 1995; 109(1): 147 - 154. [Abstract] [Full Text]