Carotid Artery Approach to Balloon Aortic Valvuloplasty in Infants with Critical Aortic Valve Stenosis

Abstract

We compare the clinical efficacy of two approaches for balloon aortic valvuloplasty (BAV) in infants with critical aortic valve stenosis. The approaches were through the carotid artery and the femoral artery. Eight catheterizations for BAV were performed in seven consecutive patients with critical aortic stenosis: four BAVs were approached through the femoral artery and four through the right common carotid artery. We inserted a 5F sheath into the right common carotid artery by a cutdown procedure; after BAV the sheath was removed and the carotid arteriotomy sutured with 7-0 monofilament. Two cases in which the femoral artery approach was used resulted in failure to perform BAV; two cases had complications. All four cases with the carotid artery approach were successful, with no complications; aortography performed 3 months after one balloon valvuloplasty revealed a smooth, unobstructed right carotid artery. Use of the carotid artery approach may reduce serious complications with BAV and offers quicker, easier maneuvering in infants and neonates with critical aortic valve stenosis.

Balloon Valvuloplasty of Aortic Valve Stenosis in Childhood: Midterm Results in a Children's Hospital, Mansoura University, Egypt

“…This approached was considered when there are problems in femoral or umbilical catheterization approach 34. Many previous studies had demonstrated the use of carotid artery approach to BAV 35,36…”

Transumbilical venous, anterograde, snare-assisted balloon aortic valvuloplasty in a neonate with critical aortic stenosis

“…Since the initial description of balloon aortic valvuloplasty in the neonate by Lababidi and Weinhaus [12], several groups of workers [6][7][8][9][10][11][13][14][15][16][17][18][19][20][21] have adopted the technique and have reported reasonably good results. Whereas Lababidi and Weinhaus [12] performed the procedure by cut-down of the femoral artery, most workers prefer percutaneous transfemoral, transumbilical, or carotid artery retrograde or anterograde transfemoral venous techniques.…”

Percutaneous Common Carotid Artery Access for Pediatric Interventional Cardiac Catheterization

“…1 As first described in children by Azzolina et al 2 in 1973, surgical carotid cutdown involved placement of a purse-string suture, followed by creation of a longitudinal arteriotomy through which catheters were placed, and tying of the purse-string suture at the end of the case. Although this approach has been widely used and is considered to be safe and effective, [3][4][5][6] it is invasive, time consuming, requires an available surgeon, and results in scarring that is cosmetically less appealing and could complicate repeat vascular access in the same vessel.…”