TCTAP C-269 Transseptal Approach for Aortic Balloon Valvuloplasty in Newborn with Critical Aortic Stenosis

Publication date: 2017

Abstract:

A femoral arterial access (5F). Catheter AR1 has been positioned in ascending aorta. Angiogram. A lot of tries to put the tip of BMW, PILOT 150 wires on AR1-3, XB, JR3-4 catheters was unsuccessful because the thin aortic valve aperture (1-2 mm). Femoral venous access has been performed (5F). MPA catheter used to pass through foramen ovale to LA and has been replaced on the wire to the XB4. Pilot 150 wire has been delivered to the LV and then by the blood flow to aorta. At this step hemodynamics of the patient became worse. We tried to deliver the balloon to aortic valve from venous side, but it resulted in tension of the system while passing the LV U-turn and we stopped to avoid the wire loss. Wire has been captured in abdominal aorta by Gooseneck retriever and has been withdrawn from arterial access. Quantum Maverick 5 x 20 RX has been delivered to the aortic valve from arterial side taking into consideration the sharp end of the wire in LV, then 16 atm predilation. Wire and balloon has been withdrawn and patient has been stabilized in 7 minutes. Echocardiography: MR was decreased to 2, no separation of pericardium, GP was 70 mm Hg. AR1 catheter has been used from arterial side and PILOT 150 easily has been passed through the valve to LV and final balloon valvuloplasty has been done with TYSHAK 10 x 30. The result is 9 mm Hg aortic valve gradient with decrease of MR, AR (++), no complications. Extubation in 10 hours and discharge from ACU in 24 hours.

Тип: Article

DOI 10.1016/j.jacc.2017.03.509