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The carotid arterial approach for balloon dilation of critical aortic stenosis in neonates—immediate results and follow-up

Published online by Cambridge University Press:  19 August 2008

Sandra Giusti ,
Adele Borghi ,
Sofia Redaelli ,
Philipp Bonhoeffer ,
Isabella Spadoni ,
Rocco Macrì  and
Mario Carminati
Sandra Giusti*
Affiliation:
From the Department of Cardiology, Ospedale Pediatrico Apuano, Massa and the Department of Cardiology, Ospedali Riuniti, Bergamo
Adele Borghi
Affiliation:
From the Department of Cardiology, Ospedale Pediatrico Apuano, Massa and the Department of Cardiology, Ospedali Riuniti, Bergamo
Sofia Redaelli
Affiliation:
From the Department of Cardiology, Ospedale Pediatrico Apuano, Massa and the Department of Cardiology, Ospedali Riuniti, Bergamo
Philipp Bonhoeffer
Affiliation:
From the Department of Cardiology, Ospedale Pediatrico Apuano, Massa and the Department of Cardiology, Ospedali Riuniti, Bergamo
Isabella Spadoni
Affiliation:
From the Department of Cardiology, Ospedale Pediatrico Apuano, Massa and the Department of Cardiology, Ospedali Riuniti, Bergamo
Rocco Macrì
Affiliation:
From the Department of Cardiology, Ospedale Pediatrico Apuano, Massa and the Department of Cardiology, Ospedali Riuniti, Bergamo
Mario Carminati
Affiliation:
From the Department of Cardiology, Ospedale Pediatrico Apuano, Massa and the Department of Cardiology, Ospedali Riuniti, Bergamo
*
Dr. Sandra Giusti, Department of Cardiology, Ospedale Pediarrico Apuano, Via Aurelia Sud, 54100 Massa, Italy.
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Summary

Balloon dilation of the aortic valve was performed in 20 consecutive neonates with critical aortic stenosis using an approach achieved by cutting down on the right carotid artery. The age of the patients ranged from one to 25 days (mean seven days) and their weight from 2.1 to 4.0 kg (mean 3.16 kg). All patients were evaluated before cardiac catheterization with cross-sectional and Doppler echocardiography so as to keep the catheterization procedure as short as possible. Balloon dilation was accomplished in all patients. The only complication was an apical perforation by the guide wire in two cases. The ensuing pericardial effusion was immediately drained with pericardiocentesis and the subsequent course of the procedure was uneventful. Immediate results showed dramatic improvement in cardiovascular conditions. The transvalvar pressure gradient fell from 80±40 to 27±20 mm Hg (p<0.001). Left ventricular ejection fraction evaluated by echocardiography increased from 30±21% before dilation to 54±18% 24-48 hours after the procedure (p<0.001). In all patients, the procedure was free from vascular complications. Aortic regurgitation was documented after the procedure in 11 patients, being severe in one, moderate in five and trivial in five. Seven patients died, although in only one was the death related directly to the procedure itself. Six patients died because of associated lesions despite an immediate satisfactory result of the balloon valvoplasty. The 13 surviving patients are doing well, and are receiving no medications. During a mean follow-up of 25 months (range 2-54 months), four patients have developed restenosis. One underwent surgical valvotomy at one year of age. The second was successfully redilated through the same approach at two months of age. The other two have a significant gradient, as assessed by Doppler measurements (60 and 70 mm Hg), with normal systolic ventricular function. Two patients have moderate aortic regurgitation. Balloon dilation achieved through cutdown on the right carotid artery is a safe and effective alternative to surgery in neonates with isolated aortic stenosis. The unfavorable results are mainly due to associated anomalies.

Keywords

Neonatal aortic stenosisballoon dilationcarotid approach
Type
Original Articles
Information
Cardiology in the Young , Volume 5 , Issue 2 , April 1995 , pp. 155 - 160
Copyright
Copyright © Cambridge University Press 1995

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